Multiple Sclerosis Flashcards
(51 cards)
What is multiple sclerosis
Inflammatory demyelinating disorder the central nervous system
Autoimmune reaction against myelin
Characterised by distinct episodes of neurological deficits, separated in time
Is MS more common in men or women
Women
3:1 ratio
At what age does MS usually present
20s - 40s
What are the risk factors for MS
Link with the EBV
Vit D deficiency may be associated
Gets more common the further from the equator you go - for both northern and southern hemispheres
Genetic predisposition and environmental trigger
What is the most common clinical course for MS
Relapsing and remitting - periods of illness followed by a good period
Some go onto be secondary progressive – relapse pattern which then starts getting slowly worse
What is a progressive relapsing (secondary progressive) illness pattern
Periods of illness/symptoms that do get better but you never get back to baseline
Get progressively worse each time
What is a primary progressive disease pattern
Just gets gradually worse over time
What are the common clinical features of MS
Pyramidal dysfunction Optic neuritis Sensory symptoms Lower urinary tract dysfunction Cerebellar & brain stem features Cognitive impairment
However, almost anything can happen as nerves become affected
Describe pyramidal dysfunction
Increased tone - velocity dependant
Spasticity
Weakness:
Extensors of upper limbs
Flexors of lower limbs
What is optic neuritis
Painful visual loss - usually unitlateral
Caused by inflammation in the nerves that move the eyes
Worse on movement of the eye
Will get a RAPD
What are the sensory symptoms of MS
Pain
Paraesthesia
Dorsal column loss - proprioception and vibration
May get burning sensation or the feeling of water running down legs
Trigeminal neuralgia
Numbness
You should scan everyone with trigeminal neuralgia - true or false
True
Need to rule out MS as the cause
How does cerebellar dysfunction present
Dysdiadokinesis Ataxia Nystagmus Intention tremor Speech issue - dysarthria Pendular reflexes
What causes diplopia in MS
CN VI palsy
What can lead to facial weakness in MS
CNVII palsy
How does internuclear ophthalmoplegia present
Distortion of binocular vision
Failure of adduction leading to diplopia
Nystagmus
Lag -one eye will move quickly and the other will drag behind it
What symptoms of lower urinary tract dysfunction are common in MS
Increased frequency Nocturia Urgency Urge incontinence Retention
How can you treat fatigue
Amantadine
Modafinil if sleepy
Hyperbaric oxygen
What investigations would you do for MS
MRI of brain and spinal cord - will show lesions (usually in white matter)
CSF - look for IgG oligoclonal bands
Blood tests - inc. B12/folate, connective tissue screen
What other diagnosis can present similarly to MS
Vasculitis Granulomatous disorder Vascular disease Structural lesion Infection - HIV, syphilis and Lyme disease Metabolic disorder
What would you expect to to see in the CSF of someone with MS
Unmatched oligoclonal bands
seen in 90% of cases
How do you manage an acute exacerbation of MS
Mild - just symptomatic
Moderate - oral steroids
Severe - admit and give IV steroids
Balance risk of steroids with benefits of treatment
What are the risks of steroid treatment
Hypertension
AVN
How can you treat pyramidal dysfunction
Physiotherapy
Occupational therapy
Anti-spasmodic agent - baclofen, tizanidine, botox
