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Long Case - Neurology > Multiple Sclerosis > Flashcards

Flashcards in Multiple Sclerosis Deck (8)
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What is MS? progress of Disease?

Demyelinating neurological condition where discrete plaques of demyelination occur throughout the CNS due to a T-cell mediated immune response.

Most common patter is relapsing-remitting caused by incomplete healing of demyelination. Prolonged demyelination causes axonal loss and SECONDARY PROGRESSIVE MS. (happens in 80% - of which 50% by 10 years)

EPIDEMIOLOGY: 20-40 years, F3:M1, caucasians far from equator


Presenting Symptoms:

ATTACK = neurological deficit lasting > 1 h and with >30 days between them

usually present with one symptom:
- arm or leg weakness
- limb paresthesia
- Optic Neuritis 20% of 1st presentations = unilateral pain on eye movement with reduced VA
- Ataxia/Dysarthria/tremor = Charcot's triad
- Band sensation around trunk or limbs

less common: vertigo, CN, urinary urgency, fecal incontinence, impotence, depression, euphoria

Usually full recovery between attacks that gradually become incomplete


Other Hx to ask

Precipitating factors: Heat, infection, fever, exercise, post partum
FHx: 7x more likely in immediate relatives
Social Disability
Ix and Tx so far



Motor: spastic paraparesis
Sensory: posterior column loss (fine, vibration, proprioception)
Cerebellar signs: nystagmus, slurred speech, impaired coordination
CN: decreased VA, central scotoma, internuclear ophthalmoplegia (adduction weakness with nystagmus in abducted eye - bilateral finding)
Lhermitte's sign: neck flexion causes electric shock in trunk/limbs


Diagnostic Criteria

McDonald Criteria:
2 acute neurological episodes separated in time or place
1 acute neurological episode + MRI evidence of typical lesion in separate region



MRI +/- gadolinium T1, T2 weights - looking for demyelinated sites
Evoked Response testing (visual- delayed in 80%, auditory or somatosensory)
CSF - oligoclonal IgG bands on electrophoresis


NP Management:

Support Groups
Bed rest with nursing during relapses
Regular exercise, stop smoking and avoid stress


P Management:

Steroids (methylprednisolone) for acute relapses - shortens relapse but doesn't alter prognosis

Interferons and monocolonal AB reduce relapse freq

Dimethyl fumerate + immunosuppressives (methotrexate and azathioprine) can be trialed

spacticity = baclofen (GABA agonist)
Bladder dysfunction = ocybutynin + amitriptyline
Facial spasm = carbamazipine
Tremor = clonazepam or propanolol