Neuro - MS

Question 1

What does MS involve

Answer 1

inflammatory process involving demyelination of neurones in the CNS

Question 2

What cells produce myelin?

Answer 2

CNS - oligodendrocytes

PNS - schwann cells

Question 3

how to describe MS lesions?

Answer 3

disseminated in space and time

Question 4

causes

Answer 4

multiple genes 
low vitamin D
smoking 
obesity 
EBV

Question 5

timing

Answer 5

progress over more than 24 hours

first presentation - last days-weeks then improve

Question 6

most common presentation

Answer 6

optic neuritis

Question 7

optic neuritis

Answer 7

demyelination of optic nerve and loss of vision in 1 eye

Question 8

why may patients present with double vision?

Answer 8

6th cranial nerve lesions

Question 9

6th cranial nerve palsy - 2 key phrases

Answer 9

internuclear ophthalmoplegia

conjugate lateral gaze disorder

Question 10

lateral gaze disorder example

Answer 10

lesion affecting left eye
look to left - right eye adduct
left eye remain in centre

Question 11

Lhermitte’s sign

Answer 11

electric shock sensation down spine and into limbs when flexing the nerve

Question 12

what does Lhermitte’s sign indicate?

Answer 12

disease in cervical spinal cord in dorsal column

Question 13

2 types of ataxia

Answer 13

sensory and cerebellar

Question 14

sensory ataxia

Answer 14

loss of proprioceptive sense
joint position
positive rombergs test

Question 15

cerebellar ataxia

Answer 15

problems cerebellum coordinating movement

suggests cerebellar lesions

Question 16

types of MS

Answer 16

relapsing remitting
primary progressive
secondary progressive

Question 17

can MS be diagnosed on one episode?

Answer 17

no - not disseminated in space and time

Question 18

most common type at diagnosis

Answer 18

relapsing-remitting

Question 19

investigations

Answer 19

MRI scan
Lumbar puncture
electrophysiology - visually evoked potentials

Question 20

LP findings

Answer 20

oligoclonal bands - CSF

Question 21

4 main features of optic neuritis

Answer 21

central scotoma
pain on movement
impaired colour vision
afferent pupil defect

Question 22

other causes of optic neuritis

Answer 22

sarcoidosis 
SLE
DM
lyme disease 
mumps and measles

Question 23

treating relapses

Answer 23

methylprednisolone 500mg for 5 days

Question 24

symptomatic treatment

Answer 24

exercise 
amitriptyline and gabapentin 
SSRIs
baclofen/physio
anticholinergic medications

Question 25

what scoring system is used to predict likelihood of MS?

Answer 25

Mcdonalds criteria

Question 26

Preventing exacerbations

Answer 26

IFN-beta
IV emthotrexate
natalizumab