Overview

• Chronic, degenerative disease of the CNS caused by immune-mediated inflammatory processes → results in demyelination and axonal degeneration in the brain and spinal cord
  • Relapsing-Remitting Disease (85%) ⇒ acute attacks (last 1-2 months) followed by periods of remission
  • Secondary Progressive Disease ⇒ relapsing-remitting patients who have deteriorated and have developed neurological signs and symptoms between relapses
  • Primary Progressive Disease ⇒ progressive deterioration from onset
  • Forms of MS
• Dissemination in Time and Space → lesions in the CNS must have occured in at least 2 different places and at least 2 different times
• F>M (3:1), peak incidence 20-40 yrs old, increased prevalence in white population
  • Most common = young white female
• Aetiology → genetic predisposition & environmental risk factors (low vitamin D levels, smoking, EBV)

Making Diagnosis

Clinical Features:

• Significant Fatigue & Headache
• Optic Neuritis (earliest manifestation - inflammation of optic nerve) → unilateral, impaired vision and colour blindness. May also have pain in moving eye. RAPD.
  • RAPD ⇒ assessed via swinging flashlight test. Both pupils appear dilated when affected eye is illuminated.
• Sensory Disturbance (patchy paraesthesia)
• Weakness after walking
• Spasticity, Hyperreflexia and positive Babinski Sign → UMN signs
• Intranuclear Opthalmoplegia (INO)
  • Lesion of the medial longitudinal fasciculus, blocking the connection between the contralateral sixth nerve nucleus and the ipsilateral third nerve nucleus, thus affecting horizontal gaze.
  • Causes ipsilateral impaired adduction (move temporally) in the eye and nystagmus in the other abducting (move nasally) eye.
  • Right INO = right eye unable to adduct (nystagmus will occur in left eye simultaneously - ie. when left eye is abducting)
• Leg cramping
• Bladder disorders (Urinary Incontinence) → may need to self-catheterise

Investigations: