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
How are acute attacks treated?
3-5 day of IV pulse methylprednisolone, 1g/day
(can sometimes use oral)
How is MS diagnosed?
Clinical diagnosis - McDonald criteria
Requires lesions disseminated in time and space
MRI is sensitive not specific for plaques
In secondary progressive MS do patient still get acute attacks of neurological deficit?
Can do but not necessarily
What are some common first presenting symptoms of MS?
How does MS present clinically?
Unilateral optic neuritis (pain on ete movement and rapid decrease in central vision)
Numbness or tingling in the limbs
Brainstem or cerebellar symptoms
What is the natural history of MS?
Relapsing and remitting symptoms as demyelination heals poorly.
Prolonged demyelination causes axonal loss and clinically progressive symptoms
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
Where are plaques typically located?
How can a MS relapse present?
Is complete loss of vision a standard feature of optic neuritis?
Vision loss ranges from mild to profound
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
What are some DDx of MS?
What is MS?
Discrete plaques of demyelination occur at multiple CNS sites due to T-cell mediated immune response
What are some common symptoms of MS?
Bowel and bladder problems
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