Multiple Sclerosis Test Questions and Answers

Multiple Sclerosis Test Questions and Answers Multiple Sclerosis (MS) Definition - Answer-Multiple Sclerosis (MS) is an acquired disease of demyelinating plaques within white matter of the CNS disseminated over space and time It is characterized by relapsing and remitting, or progressive, neurologic deficits in multiple areas of the CNS over time. Epidemiology of MS - Answer-MS has a predilection for white matter in the CNS T cell auto-immune mediated destruction of myelin sheathing with relative preservation of the axons 2X more common in women than men Higher risk in higher socioeconomic class Caucasians at higher risk Patients typically age 20-40 More common in the northern regions of Europe and the US - prevalence as high as 1 per 1000 Temperate climates In US and Europe the most frequent cause of chronic neurologic disability among young and middle aged persons MS Plaques - Answer-White matter gliotic lesions Cluster around periventricular areas, spinal cord, cerebellum, brain stem Myelin sheaths destroyed The 4 Types of MS - Answer-Relapsing - Remitting Primary - Progressive Secondary - Progressive Relapsing - Progressive Relapsing-Remitting MS Definition - Answer-Episodes of acute worsening with recovery and a stable course between relapses Primary - Progressive MS Definition - Answer-Gradual nearly continuous neurologic deterioration from the onset of symptoms Secondary - Progressive MS Definition - Answer-Gradual neurologic deterioration with or without superimposed acute relapses in a patient who previously had relapsing- remitting MS Relapsing - Progressive MS Definition - Answer-Gradual neurologic deterioration from the onset of symptoms but with subsequent superimposed relapses MS Early Sx - Answer-The earliest symptoms are often of a young person who notes tripping over curbs or uneven sections of pavement. Heaviness or numbness of both legs Some pts experience a decrease in their sense of well being. Even without specific complaints objective findings may reveal weakness and spasticity in one or both legs Clinical Presentation of MS - Answer-Patient present with neurologic complaints that are separated in time and space and cannot be explained by a single lesion. Limb weakness Paresthesias Diplopia Urinary retention Vertigo Many of the symptoms of MS are related to spinal cord involvement Symptoms can have the **hallmarks of UMN lesions especially in the lower extremities w/spastic paresis, hyperreflexia and clonus, and a + Babinski Neurologic symptoms can wax and wane or be progressive Exacerbating factors include : Infection Heat Trauma Pregnancy Vigorous activity MS Worsening Sx - Answer-Sensory complaints ie glove and stocking numbness among other complaints but frequently there are no objective findings on exam to support these complaints Optic neuritis is another common complaint in MS - this presents as blurring, darkening of vision or scotomas, pts may also complain of a dull ache in the eye. Swelling of the optic disc may be noted consistent with optic neuritis or retrobulbar neuritis Charcots Neurological Triad - Answer-The classic triad in MS : 1) Scanning speech 2) Intranuclear ophtalmoplegia (INO) nystagmus 3) Intention tremor MS Brainstem and Cerebellar Signs - Answer-Intention tremor Ataxic gait Dysarthric speech Internuclear ophthalmoplegia (INO) Diplopia Nystagmus Trigeminal Neuralgia