Multiple Sclerosis Flashcards
State the pathological and clinical definitions of MS [2]
Pathological Definition: Inflammatory disease of the CNS characterised by demyelination and variable degrees of axonal loss and gliosis.
Clinical Definition: Objective CNS dysfunction, i.e. involvement of two or more white matter structures (space) separated by time, with no other aetiology.
Describe gross pathological of MS patients [1]
Increased dark spots of white matter (where myelination has been lost) [1]
Peak age of MS onset is between [] years.
The rate of MS in [males / females] is increasing rapidly while the [female / male] rate of MS has remained stable.
Peak age of MS onset is between 20-40 years.
The rate of MS in females is increasing rapidly while the male rate of MS has remained stable.
Deficiency in which vitamin is associated with MS? [1]
Vitamin D - theres a geographical distribution
Describe the histopathological changes that occur in MS [3]
- Perivenular inflammation
- Demyelination: ingested by macrophages
- Gliosis (axons replaced by scar tissue)
Which viral infection is assocaited with MS? [1]
Infection from Epstein-Barr Virus
(no evidence of infection means have minimal chance of MS)
[] is a risk factor for multiple sclerosis
Smoking is a risk factor for multiple sclerosis
Describe the overall disease progession of MS [2]
Get periods of inflammation
AND
Overall progressive cerebral atrophy: ventricles get larger
What are oligoclonal bands and how are they used in the diagnosis
Oligoclonal bands:
- IgG unique to CSF: indication that there is an immune process being driven in the CNS.
- Very consistent finding for patients with MS
- Take samples from CSF (lumbar puncture) & blood and compare
Describe the genetic link between MS [2]
Over 200 genes associated with MS
The more genetically close you are to a sufferer of MS the higher chance of suffering, but NOT a Mendelian disease
The effect of which genetic region dwarfs that of any other genetic region associated with MS? [1]
HLA
(But still very multi-gene implicated)
Describe the signs and symptoms of MS [8]
Motor - spasticity, weakness and gait abnormalities.
Sensory - positive (pins & needles) and negative sensory phenomena (loss of sensation).
Cerebellum - inco-ordination and unsteady gait.
Brain Stem - diplopia, vertigo, nystagmus, dysarthria
Optic Nerves - optic neuritis (blurred vision)
Bladder and Bowel - incontinence
Higher Functions - depression, poor concentration, forgetfulness, etc.
Fatigue
All patients present differently. Not going to be all of them
Describe the different clinical subtypes of MS [3]
Primary progressive MS:
* Steady increase in disability without attacks
Relapsing-remitting MS
* Unpredicatable attacks which may or maynot leave permanent deficits followed by periods of remission
Secondary progressive MS
* Initial relapsing-remitting MS that suddenly begins to have a decline without periods of remission
Describe the approaches of treatment for MS [2]
Immunomodulatory/immunosuppressant:
* Mainstay of traditional treatment
* dampens down the immune system
Induction therapy
* “Reset” the immune system
* Higher risk (in the short term)
* Long-lasting disease remission off treatment
A 26 year old female, with previous history of myelitis, presents with double vision on looking to the left.
Internuclear ophthalmoplegia
Which eye reflex is often severely impacted in MS? [1]
swinging light reflex
State what has occured in this MS patient [1]
BBB broken down
What is the name for this sign of MS on MRI? [1]
Dawsons fingers
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
State which of the following pattern of MS is depicted
Primary progressive MS (PPMS)
Relapsing-remitting MS (RRMS)
Secondary progressive MS (SPMS):
Clinically isolated syndrome (CIS)
