Multiple sclerosis Flashcards Preview

Neurology > Multiple sclerosis > Flashcards

Flashcards in Multiple sclerosis Deck (25):
1

Definition of MS

Inflammatory demyelinating condition of the CNS

2

Clinical course of MS (4)

1. Relapsing-remitting
2. Secondary progressive
3. Primary progressive
4. Clinically isolated syndrome

3

Motor symptoms (2)

Increased tone
Spastic weakness

4

Symptoms of optic neuritis (4)

Pain
Decreased visual acuity
Washed-out colours
RAPD

5

Sensory symptoms (4)

Pain
Paraesthesia
Numbness
Dorsal column loss

6

Internuclear opthalmaplegia is caused by damage to the...

medial longitudinal fasciculus

7

Clinical signs of internuclear opthalmoplegia (2)

Failure of adduction of the contralateral eye during lateral gaze; also see nystagmus in abducting eye.

8

How does internuclear opthalmoplegia present? (2)

Diplopia, distortion of binocular vision

9

Examples of autonomic dysfunction in MS (4)

Urinary urgency
Incontinence
Urinary retention
Erectile dysfuncion

10

What are the McDonald criteria for diagnosis?

Two or more CNS lesions with corresponding symptoms separated in time and space

11

Investigations in MS:
a) Lumbar puncture
b) MRI brain, cervical and thoracic spine
c) evoked potentials

a) to exclude infection/inflammatory cause. CSF shows oligoclonal bands in 90%
b) plaques show up as high-signal lesions
b) evoked responses are delayed

12

What does the presence of oligoclonal bands in the CSF suggest?

Suggests IgG response in the CNS (not present in the serum)

13

Management of acute exacerbations(1)

Steroids (if severe, admit and give IV)

14

Treatment of spasticity (1)

Antispasmodic e.g. baclofen. Botox injection if localised

15

Treatment of neuropathic pain (2)

Gabapentin, amitriptyline

16

Treatment of bladder disturbance (2)

Anticholinergics e.g. oxybutyinin, self catheterization

17

Amantadine is indicated for...

Treatment of fatigue

18

Drug to treat daytime sleepiness

Modafinil

19

First-line disease modifying treatment (2)

Interferon beta
Glitiramer acetate

20

What is the aim of disease modifying treatment?

To reduce relapse rate in relapsing-remitting MS

21

What is Lhermitte's phenomenon? In which other conditions is this seen?

Electric shock-like sensation in the arms and legs precipitated by neck flexion. Cervical spondylosis, SCDC, cord tumours

22

Motor signs in examination in MS (3)

UMN signs e.g. brisk reflexes, spasticity, reduced power)

23

Findings on visual examination in MS (4)

Impaired visual acuity
There may be central scotoma/field defects
RAPD on swinging flashlight test
Internuclear opthalmoplegia

24

Cerebellar signs in MS (DANISH)

Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Slurred/staccato speech
Hypotonia

25

Good prognostic features (6)

Female
Young age of onset
Relapsing remitting
Sensory only
Long interval between first two relapses
Complete recovery between relapses