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MS def
Chronic, demyelinating disease of the CNS
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Disease typically affects
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Exacerbation
- relapse
- period of acute symptoms worsening
- increased with fatigue and hot temps
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Remission
- a period free of evolving (new) symptoms
- unpredictable and variable
- each baseline of remisson can be worse & worse
- *can be caused by oligodendrocytes to recover and remyelinate never fibers
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Sclerotic plaques
means scar tissue
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Charcot's Triad
- intention tremor
- scanning spech
- nystagmus
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Nystagmus
rapid eye movements
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Scanning Speech
- low volume with slurred speech, long pauses and disrupted melody of speech
- occurs because of incoordination of tongue and oral muscles
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MS Etiology
- Currently believed to be an auto-immune disease attacking the CNS
- some researchers believe it could be slow exposure virus and genetic
- different areas have higher incidences of MS
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Damage is to the Oligodendrocytes
- cells that make myelin
- this slows nerve transmission
- eventually can lead to transmission block
- axon damamge can also occur
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MS Pathophysiology
local inflammation, edema, and infiltrates surrounding acute lesions can cause disruption of nerve function
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Scotoma
dark spot in the middle of the eye
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MS Clinical Features
- Paresthesias or numbness
- Dysesthesia
- Trigeminal Neuralgia
- Lhermitte's ssign
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Paresthesias
pins and needles
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Dysesthesia
- Burning or achin pain
- can also be called paroxysmal limb pain
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Trigeminal Neuralgia
- Also known as tic douloureux
- attacks of stabbing pain in the face
- results from demyelination of sensory fibers of the trigeminal nerve (cranial nerve 5)
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Lhermitte's Sign
- indicates dorsal column damage
- pts feel "electric shock" down spine into legs with cervical flexion
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Signs of damage to corticospinal tract of Motor cortex
- Falling or dragging of foot, LE weakness
- Spacitiy 80%
- LE usually more involved than UE
- Mild paresis can increase to total paralysis
- brisk tendon reflexes, involuntary spasms
- movements are slow, stiff, and weak with abnormal timing
- disturbed agonist and antagonist relationships
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Dysdiadochokinesia
- rapid alternating movements
- self feeding, bringing spoon to mouth and back to bowl
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Motor Impairments Associated with Cerebellar Damage
- Ataxia, Dysmetria, and dysdiadochokinesia
- ataxic gait-WBOS, staggerings slow uncoordinated advancement of LE
- poor balance
- postural tremors
- intention tremors with voluntary actions
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Involvement of brain stem can lead to
- Dysphagia
- Dizziness and vertigo
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Fatigue in MS
- 75%-90% say it is the worst symptom
- correlation with depression
- usually in pm
- heat and humidity exacerbate faituge
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Depression
up to 50% of pts
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Euphoria with Emotional Dysregulation
- exaggerated sense of well-being incongruent with actual status and incidents of uncontrollable laughter and crying
- this occurs more frequently with MS than any other neurological diseases
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Lability
occurs as some pts fluctuate between euphoria and uncontrollable crying
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