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Multiple Sclerosis Notes

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This is an extract of our Multiple Sclerosis document, which we sell as part of our Neurology Notes collection written by the top tier of University Of Leicester students.

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Multiple Sclerosis Demyelination of the CNS causing relapsing and remitting neurological disturbance

EpidemiologyCommoner in temperate areas Lifetime UK risk 1:1000 F>M 2:1 Mean age of onset is 30 years

Aetiology/PathogenesisGenetic susceptibility + environmental trigger Myelin is lost from the brain + spinal cord (throughout the CNS, but not peripheral nerves) Leads initially to a relapsing (demyelination) and remitting (remyelination) neurological disturbance but ultimately in all but a few patients to a permanent and progressive disability as a result of loss of axons

Clinical features-

Presentation is usually monosymptomatic o Unilateral optic neuritis
? Pain on eye movement and rapid deterioration in central vision o Numbness and tingling in limbs o Leg weakness o Brainstem/cerebellar symptoms e.g diplopia/ataxia Symptoms may worsen with heat or exercise Possible features o Optic neuritis:
? Acute phase - central visual field defect, worse on eye movement, often normal fundoscopy, usually recovers in 10-20 days
? Chronic phase - fundoscopy shows optic atrophy (pale disc), visual loss often minor (i.e reduced colour vision) o Motor weakness
? Due to pyramidal tract damage (UMN)
? Weakness - arm extension/leg flexion
? Spasticity - increased tone, "claspknife" pattern
? Increased reflexes +/- clonus +/- upgoing plantars o Sensory loss
? Altered sensation
? Can occur anywhere
? If isolated symptom, differential = hyperventilation, peripheral neuropathy o Cerebellar signs often prominent e.g ataxia, intention tremor, scanning speech o Brainstem involvement
? Internuclear opthalmoplegia casing a dysconjugate eye gaze
? Trigeminal neuralgia-like syndrome
? Recurrent facial nerve palsy

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