Multiple Sclerosis examination

Multiple Sclerosis examinationCreated OnJune 2, 2020Last Updated OnJune 2, 2020byadmin You are here: Main Clinical Examination Multiple Sclerosis examination < All Topics Table of Contents Physical examination: General Attached with urinary catheter Unstable mood (Depression) Speech: Dysarthria Cognitive impairment Skin – skin sclerosis Motor System Increased tone (Hypertonia) Ankle Clonus present Localised weakness (Poor power) Hyperreflexia reflexes Babinski sign positive Sensory System Focal sensory disturbances (persistent decrease of proprioception and vibration) Cranial Nerve Optic – Optic neuritis Trigeminal – Trigeminal neuralgia Facial – Bilateral facial weakness Lhermitte’s Sign Flexion of the neck may induce a tingling, electric shock like feeling down the shoulders and back. Cerebellum Poor coordination (Ataxia) Intentional Tremor Gait: Broad-based gait Inability to tandem walk Ophthalmo-logical Examination Loss of visual acuity Visual field defect – Hemianopia Disturbed colour perception Relative afferent pupillary defect +ve Optic disc pallor Nystagmus Internuclear ophthalmoplegia (slowness or loss of adduction in one eye with nystagmus in the abducting eye on lateral gaze) – Diplopia Abdominal Examination Inspection: Abdomen distension (Constipation) Auscultation: Reduced/Absent bowel sound. Investigation: MRI of brain and spinal cord (definite investigation) Using gadolinium MRI Shows plaques particularly in the periventricular area and brainstem CSF examination (Gold standard) Shows oligoclonal IgG bands Visual evoke potential Decrease activity Blood studies to rule out: Collagen vascular disease and other rheumatological condition Infection (Lyme disease, syphilis) Thyroid disease Vitamin B12 deficiency Sarcoidosis Vasculitis McDonald criteria for MS Attacks Lesions Additional criteria for diagnosis 2 or more 2 or more None. Clinical evidence will suffice 2 or more 1 lesion Dissemination in space on MR (Or await further clinical attack implicating a different CNS site) 1 attack 2 lesions Dissemination in time on MR (Or await further clinical attack implicating a different CNS site) 1 attack 1 lesion Dissemination in space and time on MR (Or await further clinical attack implicating a different CNS site) 0 attack 1 lesion One year of disease progression (retrospective or prospective) AND at least 2 out of 3 criteria: Disseminated in the space then brain Disseminated in space in the spinal cord based on 2 or more T2 lesions Positive CSF Management: General measure: Secure airway, breathing and circulation Measures for prolonged immobilization Urinary catheterization   Immunomodulators: SC/IV interferon Subcutaneous Glatiramer acetate Natalizumab (300 μg, IV infusion each month), Fingolimod, Cladribine, Azathioprine, Mitoxantrone.   Palliative...

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