NeuC7 Neurology MRCEM syllabus

	Idiopathic inflammatory disease diagnosed by TIME
Etiology	Inflammatory demyelinating disorder of brain and spinal cord.
Epidemiology	Age 16-50. F>M 2:1. thought to have both genetic and environmental influence. Infectious triggers?
Clinical presentation	see below ddx: many. SLE, GBS, HIV, TIA, trigeminal neuralgia...
Emergency presentations	Acute relapse → steroids only under specialist guidance Fever - control temperature Autonomic lability
Pathogenesis	lymphocytic infiltration to myelin and axons → initial remyelination → formation of sclerotic plaques
Diagnostic investigations	Rule out other acute diagnoses e.g. FBC, ESR, CT head, MRI spine (transverse myelitis) - no single diagnostic test suitable for ED - MRI brain: periventricular white matter hyperintensity
Management	- Don't assume spinal cord s/s are due to MS rather than a surgically correctable lesion - Specialist - AZT, beta interferon, pulsed methylpred - Upcoming - fingolimod, dimethyl fumarate...

clinical presentations

disease course

Highly variable, from:

age <50, AND

Babinski positive = upgoing plantars
optic neuritis (15%) - ↓ colour vision, RAPD, ↓ acuity
RAPD, Uhthoff phenomenon (worsening of vision in hot showers), phosphenes (light flashes with eye movement), Pulfrich effect (different latencies between eyes)
- BUT not diagnostic!
- action: refer to ophthal and neuro
impaired proprioception/vibration sense/..., ↑ tone.. .
but the key is the time course - i.e. the index presentation will not make the diagnosis - needs multiple presentations with neuro s/s in different areas, with resolution of s/s in between