Learning objectives
- What is MS
- Recognition of MS
- Treatment of MS
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Introduction
- Inflammatory condition of brain and spinal cord that damages myelin
- Can mimic stroke and so should be identifiable
Aetiology
- Dysregulated immune system
- Autoimmune nature of MS has long been suspected.
- Inflammation and demyelination in the CNS
- Oligoclonal bands in the CSF
Precipitants
Clinical
- Clinically isolated syndromes
- Double vision, loss of vision in one eye due to optic neuritis
- Weakness due to involvement of long tracts
- Sensory loss due to involvement of sensory pathways
- Ataxia due to cerebellar involvement
- MS is typically a chronic relapsing and remitting disease of young adults.
- Lesions separated in time and space without fever or viral illness
Investigations
- FBC, U&E, LFT, CRP, ESR
- CT: may show white matter hypodensity
- CSF: oligoclonal bands. Raised protein,
- MRI scan:multiple lesions and involves brain and cervical spine
- LP: raised protein and slight increase in WCC in 30%.Protein > 100mg/dl. No oligoclonal bands
Differentials
- Acute Disseminated Encephalomyelitis
- Susac syndrome
- Progressive multifocal leukoencephalopathy
Management
- Support, diagnosis and rehabilitation as needed
- Treat acute relapse with Methylprednisolone for disabling motor or sensory/visual relapses
- NICE recommend oral methylprednisolone 0.5 g daily for 5 days and IV methylprednisolone 1 g daily for 3-5 days as an alternative or
in those whom oral steroids have failed or not been tolerated.
References and further reading
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