Flashcards in Multiple sclerosis Deck (17):
What is the main diagnostic criteria of MS?
Demyelinating lesions in the CNS dessiminated in space and time
What should we look out on MRI?
enhanced and non enhanced lesions in CNS. enhanced lesions indicate new lesions, whereas non enhanced lesions indicates old and healed lesions
What are the patterns of MS?
Relapsing remitting (episodic attacks with transient complete recovery in between); slow progressive (gradually disabling); combination
What is INO?
intranuclear opthalmoplegia. A lesion in the MLF pathway will cause double vision when the patient looks to the side. The leading eye will demonstrate nystagmus and the following eye will not completely adduct towards the nose
Sharp shooting pain in the lower limbs when the patient looks down and bends the neck forward
--> generally indicates dorsal column involvement at a cervical level
what are the epidemiological characteristics of MS?
• More often seen in women than in men
• Temperate regions
• Associated with reduced vitamin D exposure
Usually presents between 30-40 years old
Retro-orbital pain; blurry vision (usually central), pain with eye movements. Usually the first presentation of MS
what are some autonomic dysfunctions of MS?
urinary retention, urinary incontinence, faecal incontinence
how do we diagnose MS through investigations?
• LP--> CSF has oligoclonal bands (shows inflammation) and antibodies against Myelin basic protein MBP and MOG
what is the treatment strategy for MS?
• Stress free life
• Give Vitamin D
• PRN methyprednisolone in acute relapse
• Interferons 'betaferon' immune modulating therapy (injection)
• Monoclonal antibodies- extremely potent therapy--> side effects though. Daily infusion over five days and then that’s it.
what are some things you need to ask a patient with MS?
- PADLS, CADLS, DADLS
- carer/ use of OT, physio etc
-advanced care plan
- place of birth
- family history
- affect on lifestyle and social network
- cognitive decline
what is uhthoff's phenomenon?
demyelinating symptoms are worst after heat
what are some common first presentations of MS
1. optic neuritis
2. transverse myelitis
3. brainstem/cerebellar presentation
what are some common permanent MS symptoms?
2. walking difficulty
3. bowel and bladder symptoms
5. visual disturbances
can we diagnose MS from the first presentation?
not usually we can't as the diagnosis for MS is that CNS lesions are desemminated in space and TIME.
Sometimes we can do an MRI and this will show both old and new lesions. Hence a diagnosis of MS might be made at this point
what is the most common pattern of MS?