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Neurology Year 3- K > MS- Case > Flashcards

Flashcards in MS- Case Deck (11):
1

What 3 patterns can appear with MS?

1. Relapsing remittinh-80% of new dx, periiods or remission.
↪️ then ppl will go on to have 2. 2o progressive: develops in 50% in first 10Y . Relapse becomes more frequent, w/ incomplete remission and progression.

3. 1o progressive: gradual but continually worsening sx from the dx time (10-15%)

Worsening of disability- intercurrent infx, unrelated, progression, relapse,

Involvment of optic nerve causes opric or retrobulbar neurotis.
✔️ classic: unilateral visual loss over hours to days assc w/ pain esp on movement of eye.
❗️Colour vision esp affected.
RULE: recovery.

2

What is seen in opric neuritis?

Swelling of the optic nerve head- papilloedema,
Whereas retrobulbar neuritis- theres nothing- pt sees nothing, dr sees nothing.
Both can be followed by optic atrophy.

3

What are 2 unusual but ver characteristic sx of MS?

1. Uhthoffs phenomenon: effect of heat and exertion ⬆️ sx, esp weakness of legs and cisual loss (Inability to get out of hot bath)

2. Lhermitte's sign: electric shock like sense sations down the back and sometimes the thighs on bending neck (can occur in other dx affecting cervical cord)

4

PC of MS

New /worsened neuro sx/weakness/disability (new dx or relapse of known disease)
Probs due to established MS- UTIs,
‼️
How and when did the pt first present?
Course of illness to date- if relapsing- #/Freq/nature of relapses
If new: any episodes b4 dx- loss of vision in 1 eye( optic neuritis,) paraesthesis/ loss of continence (transverse myelitis)

Ask- bladder sx? - urgency/ urge incontinence/UTIs
Catherer?/self?

Infx/fever (may worsen disability/trigger relapse)
Fatigue V common ✔️

5

What else should we ask?

PMH- obstetric hx- relapses more common after post partum

FH- 10x in 1st degree.

SH- able to work? Allowances? Ambulant/ wheelchair? Able to transfer? Carers? Family, social services, district nurse, home help?

DH:Baclofen for spasticity/ anticholinergics for inconinence
IV steroids on recent relapse (methylprednisolone)

6

P/E of an MS pt:

General app: depressed, anxious, euphoric
CNS: cerebellar dysfx- staccato speech- silavista !

Cranial nerves/ optic atrophy, afferent pupillary relfex defect: Marcus Gunn pupil - usually at level of retina or optic nerve- pts pupil contricts less upon swinging light. So appearing to dilate when bright light swuang from unnafected eye to affected one.

Nystagmus: continued controlled involuntary ussualy eye movements
(47 types ha) caffeine and nicotine are stimulants

Peripheral nerves:
Spasticity legs>arms/clonus (UMN)
Pyramidal weakness legs>arms
Brisk reflexes/finger flexion jerks/+ve Hoffmans sign (UMN)
Bilateral externsor plantar reflexes (bilateral? So lesions affect bilateral sites!)
Absent abdo reflexes
Sensation affected in patchy distribution
Finger-nose ataxia in arms
Gait- spastic and ataxic

Urinalysis: as urinary infx is common.

7

Investigations

MRI BRAIN- shows best white matter lesions
MRI SPINE- id cord sx pc.

Visual evoked potentials- delayed (slow conduction in whire matter)
LP- CSF analysis if uncertain dx
90%_ oligoclonal bands
40%- ⬆️ protein
30% ⬆️ mononuclear cells

8

How would u treat acute sx?

High dose corticosteroids for 3-5 days (speed recovery) - IV methyprednisolone-
Specialist advice regarding immunosupressants therapies like- azathioprine, IV immunoglobulin

No tx that alters disease course.

9

What about long term treatment?

MDT- physio, OT,
Interferon B for relapsing remitting: INF-B-1A/1B, Glatiramer acetate

Limoleic acid- sunflowe oil
Tx- for U incontinence and frequency.

10

Prognosis

Fav: sensory sx, optic neuritis, young.
Adverse:
Progressive, icomplete recover from initial attack,
Cerebellar ataxia, peristsent weakness.

11

MS- what happens?

Pt often female and young, 25s
MS affects the white matter of the CNS (brain and spinal cord) and ❌❌ peripheral nerves.
By definition, pt: must have at least 2 episodes (lesions) separated in both type and place (position within CNs)