Clinical Signs and Symptoms
Relapsing-remitting multiple sclerosis follows a pattern in which one develops signs and symptoms of a neurological disturbance in the brain or spinal cord. The relapses progress over a few days, stabilize, and typically resolve after a few weeks. Optic neuritis is a common presenting symptom of multiple sclerosis. It causes pain with eye movement and decreased vision in the eye affected. Other symptoms during a relapse include double vision, numbness, tingling, slurred speech, limb weakness, clumsiness, imbalance, bowel, and bladder symptoms. These symptoms can completely resolve or one may remain with a partial deficit. Additional symptoms common to patients with multiple sclerosis include fatigue, heat intolerance, depression, and spasticity. If the symptoms progress between attacks then the disease is categorized to be in the secondary progressive stage. Patients with primary progressive multiple sclerosis develop a gradual accumulation of disability without relapses.
The diagnosis of multiple sclerosis is based on clinical attacks and MRI evidence of typical lesions. The use of MRI for multiple sclerosis has evolved as a valuable tool used to establish an early diagnosis and monitor disease progression. The MRI pictures depicted indicate areas of demyelination or plaques in the cervical spinal cord (figure 7) and in the brain (figure 8). Infusion with gadolinium may reveal enhancement and would be consideredd “active” lesions (figure 9). Additional testing may be required to establish the diagnosis of multiple sclerosis. Lumbar punctures are performed to sample the cerebral spinal fluid (CSF) to examine for evidence of inflammation. We are looking for the presence of oligoclonal bands (figure 10) or an elevation of the IgG index. Visual evoked potentials may be obtained to evaluate for evidence of previous damage to the optic nerve from a demyelinating event (figure 11). At times, brainstem auditory evoked potentials or somatosensory evoked potential are obtained.