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Year 2 - Nervous > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

MS is a disease of what age

A

Young people

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2
Q

Definition of MS

A

Demyelinating inflammatory disease of the CNS

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3
Q

What occurs to axons in MS in the CNS

A

They demyelinate due to inflammation of axons –> disturbing conductance of the impulse

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4
Q

MS is a disease of grey or white matter

A

White

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5
Q

Pathophysiology of MS

A

Autoimmune process where myelin is mistaken as foreign which activates T cells to cross BBB and bind to it

The activated T cells cause the BBB to express more receptors which attracts more leukocytes to enter brain; they also produce cytokines which dilate the vessels of the BBB and allow more leukocytes to get in to promote inflammation

The activated T cells also attract B cells and macrophages - B cells produce antibodies and mark the myelin sheath proteins; macrophages recognise the marked myelin and phagocytose them which destroys the oligodendrocytes

–> ALL LEADING TO DEMYELINATION (–> plaques)

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6
Q

What is the equivalent of fibrosis in the brain

A

Gliosis - proliferation of glial cells after inflammation

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7
Q

MS is inflammatory but also…

A

Degenerative due to axonal degeneration and loss

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8
Q

Axonal loss in MS ultimately leads to what

A

Cerebral atrophy and the development of disability

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9
Q

MS risk factors (5)

A 
Genetics - polymorphism of MHC
Existing autoimmune disease
Females>males
Northern latitude
Environmental - EBV infection
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10
Q

Initial presentation of MS lasts usually how long

A

Few days, gradual onset

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11
Q

List the different things MS can present or relapse as (6)

A

Optic neuritis
Myelitis
Odd sensory symptoms - numbness, burning etc
Limb weakness
Brainstem relapse - maybe diplopia, vertigo, ataxia, aphasia, dysphagia
Neuromyelitis optica spectrum disorder

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12
Q

Brainstem relapse can present as what symptoms (5)

A 
Diplopia
vertigo
ataxia
dysphagia
aphasia
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13
Q

Definition of a relapse

A

Episode of new symptoms occurring at least 30 days from the start of the last episode

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14
Q

Describe optic neuritis + symptoms (3) /signs (3)

A

Demyelinating inflammation of optic nerve

Symptoms:
Partial visual loss
Pain on moving eye
Loss of colour vision

Signs:
Loss of visual acuity
Optic disc swelling
Relative afferent pupillary defect

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15
Q

What is relative afferent pupillary defect

A

Light directed in the affected eye will cause only mild constriction of both pupils (due to decreased response to light from the afferent defect), while light in the unaffected eye will cause a normal constriction of both pupils

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16
Q

What is retrobulbar neuritis

A

Demyelination of the posterior optic nerve

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17
Q

Investigations of optic neuritis (2)

A

Visual evoked potentials

MRI of optic nerves

18
Q

Demyelinating inflammation of nerves in the cerebellum cause relapses presenting as (3)

A

Vertigo
Nystagmus
Ataxia

19
Q

Demyelinating inflammation of nerves in the pons can present as

A

Internuclear ophthalmoplegia - affected eye can’t adduct properly

20
Q

MS can relapse or present as partial or transverse myelitis - describe what this is + symptoms (3) /signs (3)

A

Demyelinating inflammation of spinal cord

Symptoms:
Motor weakness
Paraesthesia (tingling, numb etc)
Bladder/bowel dysfunction - e.g. urinary retention, constipation

Signs:
L’hermitte sign - paraesthesias (tingling, an ‘electrical sensation’) down the spine and to the limbs, elicited by bending neck forward
UMN signs
Sensory loss/level

21
Q

MS can relapse as neuromyelitis spectrum disorder (devic’s disease) - what is this

A

If someone has optic neuritis AND transverse myelitis, associated with aquaporin-4 antibodies in the blood then they’re said to have this

22
Q

Name the 3 different types/courses of MS

A

Relapsing remitting
Secondary progressive
Primary progressive

23
Q

What is a clinically isolated syndrome in regards to MS (2)

A

First episode of neuro symptoms lasting at least 24hrs

Not all of people who experience CIS go on to develop MS

24
Q

Symptoms (6) /signs (6) of MS (hint: about the list of conditions it can relapse as)

A 
Symptoms:
Motor weakness - esp foot dragging/slapping after walking too long
Fatigue
Visual disturbance in one eye
Paraesthesia
Urinary frequency
Bowel dysfunction - constipation

Signs:
UMN signs (4)
Imbalance/ incoordination
Afferent pupillary defect

25
Q

Most people with relapsing remitting MS go on to develop what type of MS

A

Secondary progressive –> which leads to progressive disability as an attack becomes constant and you never go into remission again

26
Q

What is primary progressive MS

A

From first episode, symptoms gradually get worse

NO RELAPSES, just continuous worsening but can be periods where symptoms are stable

27
Q

What is relapsing remitting MS

A

After an episode symptoms resolve and there’s a period of remission where everything is fine but then another episode occurs maybe months or years later

Symptoms improve during remission due to some remyelination but remyelination is never complete between the bouts of attack so there’s always residual disability (which builds up over time so with more and more attacks, there’s more irreversible CNS damage)

28
Q

MS definitive diagnosis

A

2 episodes of neurological dysfunction in a different area (MULTIFOCAL) of the CNS (brain, spinal cord, and optic nerves) each time that are separated in time and space

29
Q

MS diagnosis may be clinical or MRI based - name the criteria system for these 2 types of diagnoses

A

Posers criteria - clinically diagnosing 2 episodes, may use LP also

McDonald criteria - MRI showing 2 lesions from 2 episodes, may use LP also

30
Q

For every 10 lesions, there’s approx how many relapses

A

1

31
Q

Treatment of MS can be divided into 3 parts:

A

Treat acute attack

Prevent future attacks by reducing triggers and using disease modifying treatment (immunomodulators)

Symptomatic treatment

32
Q

Initial investigations of MS (3)

Further investigations (2)

A

MRI brain
MRI spinal cord
Routine bloods - FBC, glucose etc

LP - shows raised IgG antibodies
Visual evoke potentials - somatosensory evoked potentials less so

33
Q

Acute attack treatment of MS

A 
IV methyprednisolone (IV steroids)
Symptomatic treatment
34
Q

List the options for 1st line disease modifying treatment* (immunomodulators) of RRMS

*prevent future attacks

A

Subcutaneous/intramuscular:
-interferon beta (either)
or
-glatiramer (s/c)

OR

Oral:
-teriflunomide
or
-dimethyl fumarate

i.e. you just pick one

35
Q

List the 2nd line disease modifying treatment (immunomodulators) for RRMS (3) + when they’re indicated

A

Indicated in more aggressive disease that doesn’t respond to/tolerate other agents

IV natalizumab
Oral fingolimod
IV alemtuzumab

36
Q

List the symptomatic treatment for MS

  • For spasticity
  • For sensory symptom/dysaesthesia
  • For urinary frequency
  • For constipation
  • For sexual dysfunction
  • For fatigue
  • For tremor
  • For depression
A

For spasticity - physio + muscle relaxants/antispasmodics

For sensory symptom/dysaesthesia - gabapentin (Anticonvulsant), amitriptyline

For urinary frequency - lifestyle measures (avoid caffeine, yoga/relaxation)

For constipation - laxatives

For sexual dysfunction - sildenafil

For fatigue - exercise, good sleep pattern

For tremor - propranolol

For depression - cognitive behavioural therapy, anti-depressants

37
Q

Side effects of 1st line disease modifying treatments (immunomodulators) of MS

i.e. :
subcutaneous/intramuscular:
-interferon beta (either)
or
-glatiramer (s/c)

OR

Oral:
-teriflunomide
or
-dimethyl fumarate

A

Flu symptoms - fever, cough, sore throat, runny nose etc

Injection site reaction

Abnormal FBC and LFTs

38
Q

Side effects of 2nd line disease modifying treatments (immunomodulators) of MS

A

Suppress the immune system which can re-activate the JC virus –> progressive multifocal leukencephalopathy (PML) = fatal inflammation of brain

39
Q

MS is what type hypersensitivity reaction

A

Type IV

40
Q

Charcot’s neurological triad is a common symptom profile associated with MS - what are the 3 symptoms

A

Dysarthria
Nystagmus
Intention tremor

41
Q

A common presenting symptom of MS is damage to the medial longitudinal fasiculus (a white matter tract of CN III, IV & VI in the brainstem) - what does this present as

A

Internuclear ophthalmoplegia - impaired horizontal eye movement with weak adduction of the affected eye and abduction nystagmus of the contralateral eye.

42
Q

MS patients are sensitive to/exacerbated by cold OR heat + what implication does this have

A

heat - elevated temperatures further impair the ability of demyelinated nerves to conduct electrical impulses

  • heat temporarily worsens neuro symptoms; doesn’t actually cause the demyelination
  • often experienced as vision blurring after a hot bath or exercise (–> raised body temp)

Year 2 - Nervous (39 decks)

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