MULTIPLE SCLEROSIS-CLINICAL

SUMMARY

PRESENTATION
1. Paroxysmal symptoms make up the usual course of early disease (except in chronic progressive cases).

2. Symptoms worsen in the heat (Uhthoff phenomenon) as heat increases conduction block in demyelinated pathways.

SYMPTOMS
3. Weakness: particularly motor fatigue during sustained contraction a/w fatigue & spasticity. Pattern: LL first, flexors & hip abductors.

4. Numbness: in 1 or more limbs, tingling of the extremities & tight band-like sensations around the trunk or limbs.

5. Optic neuritis: painful loss of central vision in one or both eyes. With unilateral involvement, Marcus Gunn pupil (RAPD) is evident.

6. Internuclear ophthalmoplegia: lesion of the MLF. Unilateral adduction paresis (ipsilateral to the lesion) but convergence is intact.

7. Acute myelitis: rapidly evolving (hours or days) symmetrical or asymmetrical paraparesis or paraplegia, ascending paresthesia, sensory level on the trunk, sphincter disturbance and up-going plantars.

8. Others: pain, depression, bowel/bladder dysfunction, Lhermitte sign, cognitive impairment.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].