Demyelinating Disorders

Question 1

are the axons preserved in demyelination?

Answer 1

yes

Question 2

give examples of primary demyelinating disorders

Answer 2

MS, GBS (a few other obscure one, some occur post-infection)

Question 3

give examples of secondary demyelinating disorders

Answer 3

central pontine myelinosis, viral, toxic, GPA, sarcoid, lyme, HIV, SLE

Question 4

when does central pontine myelinosis occur

Answer 4

over rapidly corrected hyponatraemia

Question 5

what condition is guillian barre associated with

Answer 5

few weeks after campylobacter infection (also other infections)

Question 6

what is the presentation of guillian barre

Answer 6

acute
pain
ascending/proximal weakness
then paresis

Question 7

management of guillian barre

Answer 7

IV immunoglobulin

Question 8

HLA DRB1 is associated with which demyelinating disorder

Answer 8

multiple sclerosis

Question 9

risk factors for multiple sclerosis

Answer 9

female
north
vit d
FH

Question 10

what is the pathology of urinary problems in multiple sclerosis

Answer 10

detrusor sphincter dyssynergia

Question 11

what is the pathology of multiple sclerosis

Answer 11

inflam demyelinating plaques, pyramidal dysfunction

Question 12

in multiple sclerosis, what do active plaques become?

Answer 12

gliotic scars

Question 13

name the 4 types of multiple sclerosis

Answer 13

relapsing remitting
primary progressive
secondary progressive
progressive relapsing

Question 14

GO STUDY THE GRAPH OF THE CLINICAL COURSE OF THE TYPES OF MS

Answer 14

DO IT

Question 15

commonest age range for multiple sclerosis onset

Answer 15

30-40

Question 16

what eye problems can MS cause

Answer 16

optic neuritis

internuclear ophthalmoplegia

Question 17

how would optic neuritis present generally

Answer 17

acute pain RAPD

Question 18

how would internuclear ophthalmoplegia present

Answer 18

ipsilateral can’t adduct

contralateral nystagmus

Question 19

what is Lhermitte’s sign

Answer 19

in MS, electric shock sensation going down spine

Question 20

MS in the cerebellum can cause Charcot’s triad, what is this? other signs incl nystagmus, dysdiadokinesis

Answer 20

ataxia + intention tremor + dysarthria

Question 21

MS causing spasticity, increased tone, weak upper limb extensors and lower limb flexors indicates a lesion in the…

Answer 21

pyramidal tract

Question 22

MS causing a VI or VII palsy indicates a lesion in the…

Answer 22

brainstem

Question 23

investigations for MS

Answer 23

T2 weighted MRI + contrast
LP CSF
EEG
serology/renal/liver profile

Question 24

what is seen on MRI in ms

Answer 24

hyperintense white matter lesions

Question 25

what CSF abnormalities are present in MS

Answer 25

lymphocytes+ IgG oligoclonal band

Question 26

what blood abnormalities are present in MS

Answer 26

none

Question 27

diagnostic criteria for MS

Answer 27

>2 clinical/MRI episodes suggesting demyelination in separate time+ place

Question 28

what is seen on evoked potential tests in MS

Answer 28

slowed conduction

Question 29

what is the acute management of mild MS

Answer 29

symptomatic

Question 30

what is the acute management of moderate MS

Answer 30

PO CCS

Question 31

what is the acute management of severe MS

Answer 31

admit + IV CCS

Question 32

what is the 1st line disease modifying management of relapsing remitting MS

Answer 32

SC/IM interferon beta

Question 33

management of spasticity in MS

Answer 33

baclofen, tizanidine

Question 34

management of urinary symptoms in ms

Answer 34

anticholinergic oxybutynin

Question 35

management of optic neuritis in MS

Answer 35

IV methylpred then PO CCS