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neurology > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

1
Q

what is multiple sclerosis?

A

chronic cell-mediated autoimmune disorder characterised by demyelination in the CNS

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2
Q

what is the pathophysiology of multiple sclerosis?

A
  • CD4-mediated destruction of oligodendroglial cells
  • humoral response to myelin binding proteins
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3
Q

what is the pathological hallmark of multiple sclerosis?

A

plaques of demyelination and eventual axonal loss

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4
Q

what is the aetiology of multiple sclerosis?

A
  • female
  • age ~30
  • genetic - HLA DRB1
  • environmental - vitamin D
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5
Q

what are the 2 groups of MS?

A
  • relapsing-remitting - which may become secondarily progressive (80%)
  • primary progressive (10%)
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6
Q

what is relapsing-remitting disease in MS?

A
  • most common form (~80%)
  • acute attaches (e.g. lasts 1-2 months) followed by periods of remission
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7
Q

what is secondary progressive disease in MS?

A
  • describes relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
  • ~65% of relapsing-remitting progress to secondary progressive within 15 years of diagnosis
  • gait and bladder disorders are generally seen
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8
Q

what is primary progressive disease in MS?

A
  • accounts for 10% of patients
  • progressive deterioration from onset
  • more common in older people
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9
Q

what is the typical presentation of MS?

A
  • sensory disease (patchy paraesthesia)
  • optic neuritis
  • internuclear ophthalmoplegia
  • subacute cerebellar ataxia
  • spastic paraparesis
  • fatigue
  • urinary incontinence
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10
Q

how does optic neuritis present?

A
  • unilateral decrease in visual acuity over hours or days
  • poor discrimation of colours (‘red desaturation’)
  • pain worse on eye movement
  • relative afferent pupillary defect
  • central scotoma
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11
Q

what is internuclear ophthalmoplegia?

A

lesion in the medial longitudinal fasciculus (communication between the 6th nerve and 3rd nerve nucleus) of the brainstem

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12
Q

how is MS diagnosed?

A

at least two of:
* clinical history/examination
* imaging findings
* oligoclonal bands in the CSF

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13
Q

what are the typical imaging findings in MS?

A

periventricular white matter lesions seen on MRI (T2)

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14
Q

what are dawson fingers?

A
  • radiological sign in MS
  • seen on FLAIR images
  • hyperintense lesions penpendicular to the corpus callosum
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15
Q

what are oligoclonal bands?

A
  • distinct bands of immunoglobulin (Ig) G on westeron blot
  • reflect various immunoglobulins seen on CSF electrophoresis and indicate the presence of an autoimmune process in the CNS
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16
Q

what factors are associated with worse prognosis in MS?

A
  • older
  • male
  • motor signs at onset
  • early relaspses
  • many MRI lesions
  • axonal loss
17
Q

what is the management for an acute attack of MS?

A

1g of IV methylprednisolone every 24hours for 3 days

reduces the duration and severity of the individual attacks

18
Q

what is given in a severe acute attack of MS that does not respond to glucocorticoids?

A

plasma exchange

19
Q

what are the two groups of drugs used in the long-term management of relapsing-remitting MS?

A
  • disease-modifying therapies
  • symptomatic therapies
20
Q

name some examples of injectable medications used in MS?

A
  • beta-interferon
  • glatiramer

increasingly effective = increasingly significant side-effects

21
Q

name some examples of oral disease modifying agents in MS?

A
  • dimethyl fumarate
  • teriflunomide
  • fingolimod
22
Q

name some examples of biologics used in MS?

A
  • natalizumab
  • alemtuzumab
23
Q

what are the management options for spasticity?

A
  • baclofen
  • botox
24
Q

what are the management options for fatigue?

A
  • modafinil
  • exercise therapy
25
Q

what are the management options for bladder dysfunction?

A

anticholinergics

26
Q

what are the management options for depression?

A

SSRIs

27
Q

what are the management options for erectile dysfunction?

A

sildenafil

28
Q

what are the management options for tremor?

A

clonazepam

29
Q

what is the management for optic neuritis?

A
  • high dose steroids
  • recovery usually takes 4-6 weeks
30
Q

what is lhermitte’s syndrome?

A

paraesthesiae in limbs on neck flexion

indicates disease near the dorsal column nuclei of the cervical cord

31
Q

what is uhthoff’s phenomenon?

A
  • neurological symptoms are exacerbated by increases in body temperature
  • associated with multiple sclerosis

patient report symtpoms following exercise or hot showers/baths

neurology (20 decks)

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