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ENT, neuro, eyes > Multiple sclerosis > Flashcards

Multiple sclerosis Flashcards

1
Q

What is MS

A

Inflammatory demyelination of CNS

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2
Q

Risk factors for MS

A

20-50 yes
3 x more in women
FH
Higher latitudes - vit D exposure?

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3
Q

What are attaacks in MS

A

CNS demyelination develops over days to weeks
At least 24 hours can last weeks to months

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4
Q

What need for MS diagnosis

A

Multiple attacks disseminated in space and time

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5
Q

Common initial presentations in MS

A

Optic neuritis
Transverse myelitis
Brainstem inflammation

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6
Q

Who should be investigated for MS

A

Patinet with 1 or more episodes of inflammatory demyelination

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7
Q

Investigation for MS

A

MRI brain and spinal cord

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8
Q

What see on MRI in MS

A

Dawsons fingers
Periventricular plaques - white close ot ventricels
Lesions of different times and areas

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9
Q

What contrast use in MRI

A

Gadolinium contrast - differntiate between ols and active inflamamtion

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10
Q

What lesionsare enhanced with gadolinium

A

Active lesions

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11
Q

What suggests MS on LP

A

Oligoclonal bands ( not present in serum)
Inflammation and immunoglobulin synthesis

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12
Q

Diagnostic criteria for MS

A

Mcdonald criteria

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13
Q

Mcdonald criteria for MS diagnosis

A
  • If 2 or more attacks and lesions - clinical alone
  • If 2 or more attacks, 1 lesion and dissemination in space on MRI
  • 1 attack, 2 lesions and disseminated in time on MRI
  • 1 attack, 1 lesion and disseminated in space and time
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14
Q

How prove dissemination in time

A

Simultaneous asymptomatic contrast enhancing and non enhancing lesions at any time

OR

new T2 and/or contrast enhancing lesions on follow up MRI irrespective of timing

OR

await a second clinical attack

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15
Q

How prove dissemination in space

A

T2 lesion one or more in at least two MS tyical CNS regions:

  • Periventricular
  • Jaxtacortical
  • Infratentorial
  • Spinal cord
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16
Q

How diagnosie MS with no attacks

A

One year of disease progression and at least 2 out of 3 of
Disseminated in space in brain
Space in spinal cord - 2 or more T2 lesions
Positive CSF

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17
Q

Patterns of MS

A

Relapsing remitting
Primary progressive 4Secondary progressive
Progressive relapsing (steady decline, superimposed attacks)

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18
Q

Primary vs secondary progressive

A

Primary = steady decline without attacks
Secondary - initally relapsing remitting then decline without remission peridos

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19
Q

What virus has been linked to risk for MS

A

EBV

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20
Q

What is relapse in MS

A

Reported symptoms or findings - ms pathology
acute/subacute development
Last longer than 24 hours
absence fever/infection
>30 days clinical stability
Attack, exacerbation and (when it is the first episode) clinically isolated syndrome

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21
Q

What can cause worsening of MS symptoms that isnt a relapse

A

Infection or fever esp UTI
Stress/heart/over exertion
MRI if clincial uncertainty

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22
Q

How treat an MS flare

A

IV or oral prednisolone, methylprednisoloin- high dose steroids
Speed recovery time

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23
Q

Purpose of didease modifying treatments in MS

A

Reduce frequency of relaspese
Reduce progression of neurodisability
Given early when remitting relasping

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24
Q

What disease modifying treatments for MS

A

First line - interferon beta - SC
Fingolimod - oral
Alemtuzumab, nata,ocrelizumab

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25
Which medications are most effective but also most side effects/risk
Alemtuzumab etc
26
What risk is esp in MS patients with strong DMTs
Progressive multifocal leukoencephalopathy
27
What is PML
Reactiveation of JC virus in CNS -> neuro problems
28
What is uhtoffs phenomenon
Worsening of MS symptoms after heat exposure
29
How manage fatigue in MS
Cooling, pacing activities, amantaine, CBT, mindfulness
30
How manage mood and cognition in MS
CBT, SSRIs, duloxetine Social suppor, sleep/pain/depression education
31
Treatment for pain in MS
CBT Amitryptilline Gabapentin Pregabalin
32
Neurogenic bladder treatment
Fluid intake control, regimented rroutine Oxybutinin Botox Intermittent self catheterisation
33
Constipation treatment MS
- Good diet+fluid, regular laxatives, bowel care, assisted evacuation, good hygeine
34
Symptoms of neurogenic bladder
Urinary frequncy, urgency, nocutria, frequent UTIs
35
First line investigation for urinary incontinence MS
US KUB - need to check if any retnetion before treat as determines management plan
36
What is lhermittes symptom
Electric shock down bac of spine when neck flexion
37
WHo does MS affect
AI disease 40-50 years peakonset Female 3:1
38
Risk factors for multiple sclerosis
EBV - 5x Smoking Vit D Latitiude Genetics - FH, HLA, IL
39
How does MS behave in pregnancy
Experience fewer reapses while pregnant and symptoms improve 1/4 -> relapse in 3 months PP -> corticosteroids
40
First line MS in pregnancy
Interferon beta Glatiramer acetate
41
Can do MRI head in pregnancy for MS?
Yes BUT not with gadolinium scan
42
Histopathology of MS nerve cells
Multifocal demyelination Loss of oligodendrocytes Astrogliosis and loss of axons in mostly white matter
43
Clinical features of MS
Visual problems - optic neuritis inital presentaiton Fatigue Pain - neuropathic nociceptive, altered sensation Muscle spasticity, stiff + weak Mobility problems Bladder and bowel dysfunction Sexual dysfunction Depression and anxiety Congitive impairment - exec function, learning + short term mem Speech and swallowing issues
44
Optic neuritis symptoms
Tmpeorary vision loss incl scotoma, colour blindness, painful eye movements
45
Optic neuritis on fundoscope
Internuclear opthalmoplegia or pale optic disc
46
What pain experienced in MS
neuropathic and nociceptive Trigeminal neuralgia Optic neuritis Chest tightness Lhermittes sensation
47
How does spasticitiy and weakness presnet in MS
Spasticity in legs > arms Weakness - both lower limbs>one lower limb>upper AND lower limb same side>upper limb Spasms disturb sleep
48
Mobility symptoms MS
Demyelination of cerbeallar pathways -> ataxia Upper limb intention tremor - thalamus and basal anglia involvement
49
Features of bladder and bowel dysfunction
Increased frequency and urgency Urinary retention Recurrent UTIs Constipation is the most common bowel complaint
50
What causes speech and swallowing issues MS
Bulbar muscle problems -> dysarthria, dysphagia
51
First line blood tests MS
FBC Inflam markers (CNS infections, vasculitides) LFTs - chronic LD -> neuropathy, HE U+Es Calcium Glucose TFTs - hypo - fatigue, weak, constipated, slow thought Vit B12 - SACD HIV serology
52
Differentials from FBC for MS
Anaemia - amcrocytic B12 Malignancy - thrombocytopenia lymphoma
53
Why test calcium when sus MS
Can present with paraesthesia and tetany
54
Why do HIV serology when sus MS
PML due to reactivation of JCV virus Lesions occur anywhere in CNS + mimc MS
55
When is LP recommended for MS
Insufficient clinical of MRI evidence to diagnose MS Any presentation other than CIS Atypical clinical, imaging or lab findings of MS MS in atypical demographic
56
Neuromyelitis optica vs optic neuritis
NO = + for anti aquaporin antibody +/or +ve ant myelin oligodendrocyte glycoprotien
57
Transverse myelitis vs MS
Upper motor neurone signs (hyperreflexia, Babinski sign and spasticity) T2 + Gd lesions in spinal cord but NOT brain Increased WCC LP
58
Indications for DMARDs MS
Relapsing remitting disease + 2 relapses past 2 years + able walk 100m unaided OR secondary progressive disease + 2 relapses in past 2 years + walk 10m aided or unaided
59
What drug use for faituge
Amantadine
60
First line for spasticity
Baclofen and gabapentin 2nd - diaxepam, dantrolene, tizanidine
61
Bladder dysfunction how treat if significant residual volume vs if none
Intermittent self catheterisation if residual colume If no signif residual volume -> anticholinergics eg oxybutinin
62
Complications of MS
Recurrent UTIs Osteopenia, osteoprosis Depression Visual impairment Cognitive impairment Impaired mobility
63
Progosis
Less frequent initial relapses esp if years between first two = better prognosis

ENT, neuro, eyes (34 decks)

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