Multiple Sclerosis : Oneliners & Potential MCQs from Harrison's 19/e (pg 2663)
-- Examination often reveals evidence of Neurologic dysfunction, often in asymptomatic locations.
-- Exercise-induced weakness = characteristic symptom of MS.
-- Limb weakness in MS is of = UMN type.
Hence "Pyramidal signs" (spasticity, hyperreflexia, Babinski sign) present.
-- MS disrupting afferent fibers in spinal cordmay mimic LMN lesion too => a tendon reflex may be absent.
-- >30% of MS cases asso. with moderate to severe spasticity.
-- Optic neuritis presentation in MS = decreased visual acuity, dimness, decreased color perception in CENTRAL FIELD of vision.
-- Visual symptoms MCnly = monocular i.e. U/L
-- Periorbital pain precedes/accompanies visual loss.
-- Afferent pupillary defect = usually + in MS
But Uveitis = rules out the diagnosis of MS.
-- Diplopia in MS mainly d/t = Internuclear ophthalmoplegia (INO) or 6th N. palsy.
-- INO seen in MS = B/L
-- Gaze disturbances seen in MS =
1. Horizontal gaze palsy + INO ( = one and a half syndrome)
2. Pendular nystagmus
(Continued to Part 2)