Please enable JavaScript.
Coggle requires JavaScript to display documents.
MULTIPLE SCLEROSIS - Coggle Diagram
MULTIPLE SCLEROSIS
Epidemiology
Presents age 30-40
F>M
Northern european
Clinical Manifestations
Unilateral optic neuritis - painful vision loss
Diplopia - double vision
Transverse myelitis - unilateral paralysis + loss of proprioception, other side loss of pain and temperature sensation
Lhermitte sign - neck flexion elicits radiating electric shock feel
Incontinence/urinary retention
Erectile dysfunction
Bowel dysfunction
Natural history
relapsing-remitting
secondary progressive
primary progressive
Diagnosis
Req. detailed description of current neurologic symptoms, AND past symptoms which may represent unrecognized prior exacerbations
Associated symptoms include fatigue, depression, heat sensitivity, sleep disorder, cognitive impairment, unexplained chronic pain
Physical exam findings include decreased vision, impaired extraoccular movmeents, spasticity, hyperreflexia, babinski sign, gait disturbance, hemisensory loss, and paresthesias
Confirm
with
Brain MRI
w/out contrast. Consider
spinal cord MRI
w/out contrast
Evoked potentials detect electrical activity in CNS
Autoantibody testing
Symptom Management
Hospitalize, IV methylprednisolone therapy, glucocorticoid taper
Plasmapheresis in unresponsive pts
Disease-modifying therapies
Antibody therapy - use in highly active disease. high risk of side effects but effective.
Oral biologics (dimethylfumarate and fingolimod) - use in less active disease. more convenient (self-administration).
Interferon - less active disease, safest