Clinical signs and course of multiple sclerosis

1. Big picture

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of the central nervous system. Clinically, it causes neurological symptoms that are multifocal, separated in space and time, and often fluctuate with relapses and remissions.

The most important clinical rule:

MS can cause almost any CNS symptom, but the classic pattern is a young adult, especially a woman, with attacks of optic neuritis, sensory symptoms, pyramidal signs, cerebellar/brainstem signs, bladder symptoms, and fatigue.

The examiner usually wants you to recognize:

• optic neuritis;
• internuclear ophthalmoplegia;
• spastic weakness and hyperreflexia;
• sensory symptoms and Lhermitte sign;
• cerebellar ataxia, intention tremor, scanning speech;
• bladder urgency/incontinence;
• relapsing-remitting course;
• later possible conversion to secondary progressive MS.

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