Multiple sclerosis (MS) is the most common cause of progressive neurological disability in the 20-50 year age group. The Signs and Symptoms of Multiple Sclerosis is vast, early diagnosis is difficult because MS is characterised by widespread neurologic lesions that cannot be explained by a single anatomical lesion, and the various signs and symptoms are subject to irregular exacerbations and remissions. The most important issue in diagnosis is the need for a high index of suspicion.
What Causes MS? MS is a primary demyelinating disorder with demyelination occurring in plaques throughout the white matter of the brain, brainstem, spinal cord and optic nerves. The clinical features depend on their
location.
Clinical features – Signs and Symptoms of Multiple Sclerosis
> more common in females
> peak age of onset is in the fourth decade
> symptoms develop over several days but can be sudden
> transient motor and sensory disturbances
> upper motor neurone signs
> monosymptomatic initially in about 80%
> multiple symptoms initially in about 20%
> common initial symptoms include:
> visual disturbances of optic neuritis
– blurred vision or loss of vision in one eye (sometimes both)
– central scotoma with pain on eye movement (looks like unilateral papilloedema)
> diplopia (brainstem lesion)
> weakness in one or both legs, paraparesis or hemiparesis
> sensory impairment in the lower limbs and trunk
– band-like sensations
– numbness, paraesthesia
– clumsiness of limb (loss of position sense)
– feeling as though walking on cotton wool
> vertigo (brainstem lesion)
> subsequent remissions and exacerbations that vary from one individual to another
> there is a progressive form especially in women around 50 years
Neurological examination
The findings depend on the site of the lesion or lesions and include optic atrophy, weakness, hyperreflexia,
extensor plantar responses, nystagmus (two types: cerebellar or ataxic), ataxia, incoordination and regional impairment of sensation.
Signs and Symptoms of MS causing diagnostic confusion
> bladder disturbances, including retention of urine and urgency
> ‘useless hand’ due to loss of position sense
> facial palsy
> trigeminal neuralgia
> psychiatric symptoms
In established disease common sign and symptoms of ms are fatigue, impotence and bladder disturbances.
How is MS Diagnosed?
The diagnosis of MS is clinical and depends on the following determinants:
- Lesions affect the CNS white matter.
- Lesions are invariably UMN.
- >1 part of CNS is involved, although not necessarily at time of presentation.
- Episodes are separated in time (it is possible to make a diagnosis with the first episode).
Other neurological diseases such as infections (e.g. encephalitis), malignancies, spinal cord compression, spinocerebellar degeneration and others must be excluded.
For Diagnosing MS, some Lab and Imaging are needed
- Lumbar puncture: oligoclonal IgG detected in CSF in 90% of cases 8 (only if necessary)
- Visual evoked potentials: abnormal in about 90% of cases
- CT scan: rarely demonstrates MS lesions but useful in excluding other pathology
- MRI scan: usually abnormal, demonstrating MS lesions in about 90% of cases 8
