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Hugh's MD2 Core Conditions and Presentations > MS > Flashcards

Flashcards in MS Deck (16):
1

What is Lhermitte's sign? In what conditions can it be present?

Cervical flexion causes electric shock in the trunk/limbs

MS, cervical spondylosis, cord tumours and subacute combined degeneration of the cord

2

How are acute attacks treated?

3-5 day of IV pulse methylprednisolone, 1g/day

(can sometimes use oral)

3

How is MS diagnosed?

Clinical diagnosis - McDonald criteria

Requires lesions disseminated in time and space

MRI is sensitive not specific for plaques

4

In secondary progressive MS do patient still get acute attacks of neurological deficit?

Can do but not necessarily

5

What are some common first presenting symptoms of MS?

Optic neuritis

Transverse myelitis

Brainstem/cerebellar signs

6

How does MS present clinically?

Usually monosymptomatic

Can be:

Unilateral optic neuritis (pain on ete movement and rapid decrease in central vision)

Numbness or tingling in the limbs

Leg weakness

Brainstem or cerebellar symptoms

7

What is the natural history of MS?

Relapsing and remitting symptoms as demyelination heals poorly. 

Prolonged demyelination causes axonal loss and clinically progressive symptoms

 

8

How is MS managed?

Methylprednisolone, 1g 3/7 for acute relapses

Interferons reduce relapse by 30% in active relapsing and remitting

Alemtuzumab and Natalizumab in relapsing-remitting

Azathioprine may be as good as interferons in relapsing-remitting

9

Where are plaques typically located?

Corpus callosum

Symmetric periventricular

Internal capsule

Brainstem/Spinal cord

10

How can a MS relapse present?

Optic neuritis

Muscle weakness

Parasthesia

Fatigue

Cognitive dysfunction

Sexual dysfunction

Bladder/bowel dysfunction

Cerebellar symptoms

Lateral diplopia

Heat intolerance

Trigeminal neuralgia

Pain

Bipolar disoroder

Depression

 

11

Is complete loss of vision a standard feature of optic neuritis?

No

Vision loss ranges from mild to profound

12

What Ix can be performed in MS?

MRI of brain and spinal cord looking for lesions, particularly periventricular, cerebellar and in the cervical spine

 

LP for oligoclonal IgG bands which are present in 80% of cases however are non-specific and reflect only Ig production in response to ag

13

What are some DDx of MS?

Vasculitis

Friedreich's ataxia

CNS sarcoidosis

Behcet's syndrome

SLE

14

What is MS?

Discrete plaques of demyelination occur at multiple CNS sites due to T-cell mediated immune response

15

What are some common symptoms of MS?

Fatigue

Walking problems

Bowel and bladder problems

Depression

Pain

Cognitive problems

16

What questions are important to ask on MS hx?

When were you diagnosed

How has your MS progressed

How have you been treated

Have you had side effects from your treatment

Who manages your MS

Have you developed depression as a result of your MS

How has MS affected your employment

How has MS affected your ADLs

Do you need assistance with mobility