Rural Emergency Medicine

This is part of the Med in Small Doses series, which aims to give you a snapshot of a disease or disorder. For information about the series, or common abbreviations click here. Run through how to perform a neurological exam to refresh your memory, and link in clinical features.

F>M.     Prev. 1/1000.     Onset: 20-40yo.     White matter lesions.

PATHO: Genetic & environmental factors. 15x risk in 1° relatives, 150x risk in MZTs. DH2 haplotype of MHC & other genes involved. Immune response against components of myelin sheath. Lesions separated in space and time. Initiated by CD4+ Cells. TH17 Cells → demyelination.

CFs: Unilateral optic neuritis. Cranial nerve signs. Motor and/or sensory impairment, fatigue, bladder & bowel symptoms. Need at least 2 neurological events separated in time &place.

D iplopia / Dysmetria / Dysdiadochokinesis / Depression
E ye movement painful (Optic neuritis)
M otor: Weakness; spasticity
E levation in temperature (Uhthoff's phenomenon)
L hermitte's sign
I ntention tremor
N europathic pain
A taxia
T alking is slurred; dysarthria
I mpotence
O veractive bladder (urinary urgency)
N umbness (sensory defect)

  1. Relapsing remitting (85%); 
  2. Primary progressive (15%); 
  3. Secondary progressive (progression from RR); 
  4. Progressive relapsing.

MS Progression Types via Wikipedia

Ix: Plaques on MRI. CSF ↑ protein, pleocytosis, IgG, oligoclonal bands on electrophoresis.

Tx: No cure, aim to treat symptoms. Education, Physio, OT.
Acute: Methylprednisolone (high dose IV - 500mg, 5 days) or Prednisone (pts who Ø IV).
Plasma exchange.
Relapsing: Interferon β, Galtiramir, Natalizumab.  
Muscle spasticity: Baclofen, Botox, Diazepam

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