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Neurology > MS and other Inflammatory CNS Diseases > Flashcards

MS and other Inflammatory CNS Diseases Flashcards

1
Q

What is MS?

A

An inflammatory demyelinating disorder of the CNS

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2
Q

MS is associated with plaques which are?

A

Disseminated in time and place

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3
Q

What is the female to male ratio in MS?

A

3:1

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4
Q

When does initial presentation in MS tend to occur?

A

30’s-40’s

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5
Q

What are the 4 main clinical courses of MS?

A
  • Primary progressive.
  • Progressive relapsing.
  • Secondary progressive.
  • Relapsing remitting.
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6
Q

Describe secondary progressive MS.

A

Is more insidious, involves a gradual worsening of symptoms.

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7
Q

Outline the main clinical features of MS.

A
  • Pyramidal dysfunction.
  • Optic neuritis.
  • Sensory sx.
  • Lower urinary tract dysfunction.
  • Cerebellar and brain stem features.
  • Cognitive impairment.
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8
Q

What are the signs and symptoms of pyramidal dysfunction?

A

Increased tone. (velocity dependent)
Spasticity.
Weakness.

  • extensors of the upper limbs
  • flexors of the lower limbs
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9
Q

What does optic neuritis present as?

A

Painful visual loss

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10
Q

How long does optic neuritis last for?

A

1-2 weeks

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11
Q

Most people with optic neuritis improve

A

TRUE

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12
Q

What sign may be present on examination of a patient with optic neuritis?

A

RAPD - relative afferent pupillary defect

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13
Q

What sensory symptoms might a patient with MS experience?

A
  • Pain. (‘cross-wiring’ - instead of touch, you feel pain)
  • Paraesthesia
  • Dorsal column loss  Proprioception + Vibration
  • Numbness
  • Trigeminal neuralgia
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14
Q

Outline the signs and symptoms that may occur as a result of cerebellar dysfunction in MS?

A
  • Ataxia.
  • Intention tremor.
  • Nystagmus.
  • Past pointing.
  • Pendular reflexes (where reflexes continue after being elicited by tendon hammer).
  • Dysdiadokinesis (problem with co-ordination of rapid movement).
  • Dysarthria.
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15
Q

What are pendular reflexes?

A

When reflexes continue after being elicited by a tendon hammer

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16
Q

What may occur as a result of brain stem dysfunction?

A

diplopia and facial nerve palsy

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17
Q

Damage to which CN causes diplopia?

A

CN VI

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18
Q

Damage to which CN causes facial weakness?

A

CN VII

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19
Q

Imaging in MS….

A

Lesions tend to be bright on T2 weighted sequence

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20
Q

What area of the brain is affected in internuclear ophthalmoplegia?

A

Medial longitudinal fasiculus

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21
Q

What signs + symptoms does damage to the medial longitudinal fasiculus result in?

A
  • Distortion of binocular vision.
  • Failure of adduction – diplopia.
  • Nystagmus in abducting eye.
  • Lag.
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22
Q

What lower urinary tract signs + symptoms might a patient with MS experience?

A
  • Frequency.
  • Nocturia.
  • Urgency.
  • Urge incontinence.
  • Retention.
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23
Q

Name a drug which helps with fatigue in MS patients.

A

Amatandine

or hyperbaric oxygen

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24
Q

Name a drug that is given for sleepiness in MS patients.

A

Modafinil

25
Q

What are the key criteria for a diagnosis of MS to be made?

A
  • At least 2 episodes suggestive of demyelination

* DISSEMINATION in TIME and PLACE

26
Q

What investigations are done for a patient with suspected MS?

A
  • MRI
  • CSF
  • Neurophysiology
  • Blood tests
27
Q

What blood tests are done in suspected MS?

A 
Plasma viscosity, FBC, CRP
Renal liver bone profile
Auto anti body screen
Borellia, HIV, syphilis serology
B12 and folate
28
Q

What should the results for the blood tests be in MS?

A

NORMAL - you are basically trying to prove that it is nothing else causing the symptoms

29
Q

A lumbar puncture in a patient with MS is _______

A

ABNORMAL

30
Q

90% of patients with MS have abnormal LP’s

A

TRUE

31
Q

What would be seen in an LP of a patient with MS?

A

Unmatched.

Oligoclonal bands present

32
Q

Oligoclonal bands must be present for a patient to have MS

A

FALSE - even if none are detected, the patient could still have MS

33
Q

How is a MILD acute exacerbation of MS managed?

A

Symptomatic treatment

34
Q

How is a MODERATE acute exacerbation of MS managed?

A

Oral steroids

35
Q

How is a SEVERE acute exacerbation of MS managed?

A

Admit + IV steroids

36
Q

What steroid is used?

A

Prednisolone

37
Q

What are the symptoms of pyramidal dysfunction?

A

Weakness and spasticity

38
Q

What are the 3 main treatments for pyramidal dysfunction?

A

1 – Physiotherapy
2 – Occupational therapy
3 – Anti-spasmodic agent

39
Q

What are the treatment options for spasticity in MS?

A
  • Physiotherapy
  • Oral medication - BACLOFEN, TIZANIDINE.
  • Botulinum toxin
  • Intrathecal baclofen/phenol
40
Q

When is intrathecal baclofen/phenol used?

A

End of life care - relief of symptoms

- this irreversibly kills off the nerves

41
Q

What sensory symptoms are associated with MS?

A

Pain
Paraesthesia
Numbness
Trigeminal neuralgia

42
Q

What are the treatment options for the sensory symptoms caused by MS? i.e

  • Pain
  • Paraesthesia
  • Numbness
  • Trigeminal neuralgia
A 
Anti-convulsant - gabapentin
Anti-depressant - amitriptyline
TENS machine
Acupuncture
Lignocaine infusion
43
Q

How can the urinary tract be affected in MS?

A

Increased tone at bladder neck
Detrusor hypersensitivity
Detruser sphyncteric dyssenergia (sphincter problem)

44
Q

What are the signs that the LUT is affected in MS?

A

Frequency and nocturia
Urgency
Urge incontinence
Retention

45
Q

What are the treatment options for LUT dysfunction in MS?

A

Bladder drill
Anti-cholinergics ie. oxybutynin
Desmopressin
Catheterisation

46
Q

Outline the treatment options for fatigue caused by MS.

A

Amantadine
Modafinil if sleepy
Hyperbaric oxygen

47
Q

There are various disease modifying therapies used in MS. Outline the 1st, 2nd and 3rd options.

A

1st - interferon beta, tecfedira, cop axone
2nd - monoclonal antibody, fingolimoid
3rd - mitoxantrone

48
Q

How is interferon beta and cop axone administered?

A

Injection

49
Q

What is the effect of the 1st line disease modifying therapy?

A
  • decrease relapse rate by 1/3rd.

- decrease severity of relapses by 50%.

50
Q

How is tecfidera administered?

A

Oral

51
Q

What is tecfidera the 1st line treatment for?

A

RR MS (relapsing remitting MS)

52
Q

What drug Lowers white cell count so regular blood tests are required?

A

TECFIDERA

53
Q

What route is fingolimoid given via?

A

Oral

54
Q

What is fingolimoid?

A

A sphingosine 1-phosphate (S1P) modulator

55
Q

What line is fingolimoid?

A

2nd

56
Q

Fingolimoid results in a __% reduction rate in relapses

A

50%

57
Q

Name 3 monoclonal antibodies.

A

Tysabri.
Lemtrada.
Zymbata

58
Q

Who gets monoclonal antibodies?

A

Highly active relapsing-remitting MS (RRMS) patients:

  • those with rapidly evolving severe RRMS.
  • those with high disease activity, despite tx with an interferon.

Neurology (42 decks)

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