OCaPE: NSB #6
Tingling Sensation & Limb Problems
Mrs S, a forty-year-old female comes to your clinic. She complains of a tingling shooting sensation into her limbs upon flexion of her neck and blurred vision. Upon taking a history you find out she had a temporary vision impairment in one eye for a few weeks but that has now resolved.
5 minutes
Q1)
What tests would you perform next?
MRI of brain and spinal cord
Visual evoked potential
CSF examination (lymphocytes/oligoclonal bands) (3)
You’ve (hopefully) mentioned MRI. What are the advantages and disadvantages of using MRI?
Adv:
-gold standard
-excellent soft tissue differentiation
-images in any plane
Disadv:
-not as readily available and more expensive than CT
-CT better for bone
-pacemakers contraindicated (3)
What condition do you suspect?
Multiple sclerosis (1)
Name the key requirement for diagnosis of MS?
Evidence of damage to CNS/lesions separated by time and space (2)
Name 4 other symptoms of MS?
Optic neuritis- pain, impaired colour vision
Diplopia
Spastic paraparesis
Fatigue
Bladder disturbance
Erectile dysfunction
Cerebellar dysarthria
Mood disturbance (3)
What are three types of MS?
Remitting/relapsing
Primary progressive
Secondary progressive
Benign MS (2)
Name two ways to treat MS
Corticosteroids – used to reduce time to recovery following relapses but do not affect degree of recovery
B interferon – reduces immune response – benefits some patients
Copaxone- induces Th2 cells that migrate to brain and downregulate activation of pathogenic Th1 cells
Natalizumab/other appropriate monoclonal antibody – monoclonal ab to integrin molecules on t cells preventing them from crossing blood brain barrier (3)
The definite pathophysiology behind MS is not fully understood yet. There is circumstantial evidence that MS could be an autoimmune attack mediated by inflammatory cells such as T cells and macrophages.
What cells are the first line of defence in the CNS?
Microglia (1)
What are the three functional states that microglia can switch between?
Surveillance
Activated
Phagocytic (2)
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