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Multiple Sclerosis
ASSPITE of MS
13
Medical
Undergraduate 3
05/15/2008

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Cards

Term
Describe the aetiology of MS
Definition
Exact cause unkown.
1. Familial link - HLA A3/B7/D2
incs risk if 1st degree relative

2. abnormal immune response to virus. Assoc with viral infection in teenage years. abnormal cytokine response.

3. Assoc with inc consumption of animal fats.
Term
Decribe the epidemiology of MS
Definition
Females>Males
Age of onset = 20-45
Incs prevalence further away from equator
Term
What is the pathology of MS?
Definition
Plaques of demeylination in CNS.
Acute relapse caused by inflammation - local relase of NO by monocytes. Nueronal fibre damage - if serious = axonal degeneration.
Remission when inflammation ceases.
Term
Is functional recovery possible in MS?
Definition
Yes - due to increased Na+ channels in axon. BUT NO remyelination.
Term
give the 2 main types of MS.
Definition
relapsing remitting and Primary progressive
Term
how does relapsing remitting MS usually present?
Definition
1. Optic neuropathy
2. Spinal Cord Lesion
3. Brainstem demyelination
Term
What happens in optic neuropathy in MS?
Definition
Sudden onset of blurred vision. - unilateral
Anything from looking through frosted glass to complete mononuclear field loss.
Occular pain common
Resolves in 1-2months.
Optic neuritis = at nerve head - disc inflammation (papillitis)
Retrobulbar neurop = behind nerve head no signs on fundoscopy.
Afferent pupillary defect (dec motor) = dec pupil constriction.
Term
What happens in spinal cord lesions?
Definition
spastic paralysis
difficulty walking
sensory disturbances
urinary symptoms = PSNS lesion in S2-S4
Lhermittes sign = electric shock when flex spinal cord.
Term
what happens in brainstem demyelination.
Definition
limb signs if corticospinal tract involved.
acute onset of dysphagia, diplopia, facial weakness/numbness, vertigo.
charcot's triad = nystagmus/intention tremor/scnning dysarthria.
Term
What investigations would you do if you suspect MS?
Definition
neurological examination
MRI of brain and SC - plaques visible.
CSF sample = oligoclonal bands of IgG.
Term
How are acute relapses of MS managed?
Definition
High dose of short acting corticosteroid. e.g IV methyprednisolone.
Term
How are relapses of MS prevented?
Definition
Beta-interferon - immunosuppressive. Prevents T-cell maturation and corssing BBB. s/e = flu-like.
Azathioprine - supresses BM
glatramir acetate = prevents interaction between myelin basic protein and T lymphos.
Term
How are the associated signs and symptoms of MS managed?
Definition
Fatigue = amantadine
spasticity = Baclofen
Tremor = Beta-blockers
Incontinence = Anti-Ach/cathaterisation
Bowel = fleet enemas/lactulose
Pain = simple analgesics/ NSAIDs
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