Multiple Sclerosis

Question 1

What is it?

• general features? (3)
• name the 4 types of clinical course that occurs in MS?

Answer 1

-inflammatory demyelinating disorder the CNS

-Plaques disseminated in time and place
more common in females
30s & 40s

-relapsing remitting
Secondary progressive
Progressive relapsing
Primary progressive

Question 2

What are the clinical features? (7)

Answer 2

Pyramidal dysfunction
Optic neuritis 
sensory symptoms 
Lr urinary tract dysfunction 
Cerebellar & brain stem features
Cognitive impairment 
Fatigue

Question 3

Pyramidal dysfunction

-what are the features? (5)

Answer 3

-Inc tone
spasticity
Weakness
Extensors of the upper limbs 
Flexors of the lower limbs

Question 4

Optic neuritis

• what is its?
• signs?
• treatment?

Answer 4

• painful visual loss over 1-2 wks
• blurring of vision and a RAPD
• 5 days high dose methylprednisolone

Question 5

Sensory symptoms

-what are they? (5)

Answer 5

pain
paraesthesia 
Dorsal column loss >> proprioception and vibration 
Numbness
trigeminal neuralgia

Question 6

Cerebellar dysfunction

-features?

Answer 6

Ataxia
intention tremor
nystagmus 
Past pointing
Pendular reflexes
Dysdiadokinesis 
Dysarthria

Question 7

Brain stem dysfunction

-features? (2)

Answer 7

-Diplopia

Facial weakness

Question 8

Internuclear ophthalmoplegia

-features? (5)

Answer 8

• Medial longitudinal fasciculus
• distortion of binocular vision
• Failure of adduction (diplopia)
• Nystagmus in abducting eye
• Lag

Question 9

Lower urinary tract dysfunction?

-features (5)

Answer 9

frequency 
nocturne
urgency
Urge incontinance
retention

Question 10

how is fatigue managed? (3)

Answer 10

Amantadine
Modafinil if sleepy
Hyperbaric O2

Question 11

What is required for a diagnosis of MS? (3)

• investigations?
• what is seen on CSF PCR?

Answer 11

-at least 2 episodes suggestive of demyelination
dissemination in time and place
McDonald criteria

-Clinical
+ MRI, CSF, Neurophyisology
Blood tests

-Oligoclonal bands (indicates CNS inflammation)

Question 12

What would be expected on bloods? (7)

Answer 12

negative:
 PV, FBC, CRP
renal liver bone profile 
Autoantibody screen 
Borellia, HIV, syphilis 
B12 and folate