Nervous System > Multiple Sclerosis > Flashcards

Multiple Sclerosis Flashcards

(37 cards)

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1
Q

What is multiple sclerosis?

A

Inflammatory condition of the nervous system causing demyelination of the nerves in the CNS

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2
Q

What is the pattern of MS?

A

Focal disturbance of the the function of nerves occurs in episodes and follows a relapsing remitting occur.

Episode of demyelination —> malfunction —> remission (pattern and episodes are different for everyone)

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3
Q

How does demyelination occur?

A
  • Auto-immune process
  • Activated T cells cross blood brain barrier
  • Acute inflammation of myelin sheath
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4
Q

What occurs after the episode of demyelination?

A

Post-inflammatory gliosis -> functional deficit

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5
Q

What is gliosis?

A

Reactive change (proliferation or hypertrophy) of glial cells in response to damage to the central nervous system (CNS)

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6
Q

What does MS look like on an MRI scan?

A

Lesions and plaques (white blobs)

Axonal loss appears as black holes (in progressive disease)

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7
Q

Is an MRI scan diagnostic of MS?

A

No, as blobs can present in old age - need to diagnose it clinically

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8
Q

What does axonal loss lead to?

A

Disease progression and development of persistent disability

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9
Q

What is the aetiology of MS?

A
  • Genetic inheritance
  • Association with autoimmune disease
  • Female

More prevalent the further away from the equator

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10
Q

At what age does MS usually present?

A

20s and 30s

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11
Q

What are the symptoms of relapse?

A
  • Optic neuritis
  • Sensory - i.e. numbness
  • Limb weakness
  • Brainstem diplopia/Vertigo/Ataxia-
  • Spinal cord - bilateral symptoms and signs +/- bladder
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12
Q

What are the symptoms of optic/retrobulbar neuritis?

A
  • Subacute visual loss
  • Pain on moving eye
  • Colour vision disturbed
  • Usually resolves over weeks
  • Initial swelling optic disc
  • Optic atrophy seen later
  • Relative afferent pupillary defect
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13
Q

What is reflective afferent pupillary defect?

A

Demyelination in optic nerves, pupil doesn’t constrict as quickly as it should -> shown when shining light on eye

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14
Q

What are eight differential diagnosis’ of optic neuritis?

A
  • Neuromyelitis optica
  • Sarcoidosis
  • Ischaemic optic neuropathy
  • Toxic/ drugs/ B12 deficiency
  • Wegeners granulomatosis
  • Local compression
  • Lebers hereditary optic neuropathy
  • Infection-borrelia
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15
Q

What are the symptoms of brainstem relapse of MS?

A
  • Pons is susceptible to demyelination - internuclear ophthalmoplegia
  • Cerebellum - vertigo, nyastagmus, ataxia
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16
Q

What is myelitis?

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A

Inflammation of myelin sheath
• Partial or transverse (complete)
• Hyperaesthesia (heightened sensitivity)

17
Q

What is the differential diagnosis of myelitis?

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A 
• Inflammation due to:
- Neuromyelitis optica
- SLE
- sarcoidosis
• Infection or post infection
- (HIV, HTLV, HSV, TB, borrelia, mycoplasma etc)
• Tumour
• Paraneoplastic process
• Stroke
18
Q

What is Clinically Isolated Syndrome (CIS)?

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A

One off episode of demyelination

For MS to be diagnosed there must be further episode -> second episode occurring in a different part of the CNS

19
Q

What is the clinical definition of MS?

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A

Episodes of demyelination disseminated in space and time

20
Q

What are the symptoms of the progressive phase of MS?

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A
  • Fatigue, temperature sensitivity
  • Sensory
  • Stiffness or spasms
  • Balance, slurred speech
  • Swallowing
  • Bladder + bowel
  • Diplopia/ oscillopsia/ visual loss
  • Cognitive-dementia/ emotional lability
21
Q

How is MS diagnosed?

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A

Clinical or MRI based:
• Posers criteria (clinical)
• Macdonald criteria (MRI) - shows new areas of demyelination

22
Q

What are lesions or plaques on an MRI?

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A

Areas of demyelination - can show more inflammation areas than episode patient experiencing (scan and patient symptoms don’t often correlate)

23
Q

How do MRI scans show new areas of demyelination?

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A
  • Initial scan and then one 3 month later

* With and without use of gadolinium - new areas take gadolinium up

24
Q

What are other investigations used?

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A
  • Lumbar puncture - presence of oligoclonal bands in CSF but not serum
  • Visual/somatosensory evoked
  • Bloods - exclude other inflammatory conditions
  • CXR (rule of sarcoidosis)
25
What are differential diagnosis' of MS?
* Acute disseminated encephalopathy (ADEM) * Auto-immune conditions * Sarcoidosis * Vasculitis * Infection i.e. lyme disease * Adrenoleucodystrophy
26
What are the three types of MS?
1. Relapsing remitting (RRMS) 2. Secondary progressive (SPMS) 3. Primary progressive (PPMS)
27
What are prognostic indicators in MS?
``` Good for: • Female • Present with optic neuritis • Long interval between 1st and 2nd relapse • Few relapses in 1st 5yrs ``` ``` Bad for: • Male • Older age • Multifocal symptoms and signs • Motor symptoms and signs ```
28
What are the features of primary progressive MS (PPMS)?
* Often presents in 5th and 6th decade * No relapses * Spinal symptoms - weakness in legs * Bladder symptoms * Prognosis poor * M = F * O bands in CSF
29
What changes to MS during pregnancy?
* Fewer relapses during pregnancy | * Increased risk in first 3 months post part
30
What is the benefit of disease modifying treatment?
Reduce relapse rates
31
Give examples of 1st line disease modifying treatments
* Beta-interferons * Glatiramer acetate * Oral treatments * Teriflunomide * Dimethyl Fumarate
32
What are the side effects of MS treatment?
* Flu-like symptoms * Injection site reaction * Abnormalities of blood count and liver function
33
Name three 2nd line disease modifying agents
* Natalizumab * Fingolimod tablet * Alemtuzumub
34
Name a life threatening side effect of MS treatment
Progressive Multifocal Leukencephalopathy (PML)
35
What causes Progressive Multifocal Leukencephalopathy (PML)?
``` • JC-virus • Immunosuppression (AIDS) - Natalizumab - Dimethyl fumarate - Fingolimod ```
36
What is the symptomatic treatment of spasticity?
Muscle relaxants, antispasmodics and physio
37
What is the symptomatic treatment of dysaesthesia?
Amitriptyline, gabapentin
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