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WEEKLY TOP 7 – Top 7 clinical signs of multiple sclerosis

These days medical students are just flooded with a huge amount of information –different description of diseases, fresher and fresher publications – available online. It is really difficult to pick the clinically relevant data, especially when you do not have those years of practice behind your back. In our blog series You will find short and straightforward lists of clinical signs, symptoms which are the most typical and pathognomonic in certain diseases.

The topic of today’s blog is an incredibly versatile disease. Dear med students - future doctors, you should memorize the symptoms carefully, because this disease is quite tricky to diagnose. What could prove it better than even Mr. Tim Cook, the CEO of the legendary Apple company was misdiagnosed with this “brainy” illness: multiple sclerosis. On the occasion of World MS Day 2018, we rounded up the 7 most common symptoms of multiple sclerosis!

Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 28244

1. Fatigue

Why? First, here is a number (just to show you, I am not talking about what you feel after a long day): 65% of MS patients rated this symptom as the worst one, higher than any other symptoms! The cerebral axonal injuries, as well as other primary and secondary symptoms, play an essential role in the mechanism of the pathologic exhaustion.

2. Sensory disturbances: numbness, tingling or pain

Why? Demyelinating lesions impairing the ascending sensory pathways (spinothalamic, posterior column) or the dorsal root entry zone lead to several varying types of paresthesias. Common manifestations: positive Lhermitte-sign, intense itching sensation in the cervical dermatome or trigeminal neuralgia (& much more).   

3. Visual loss

Why? Aka optic neuritis. In MS, it means the development of inflammatory demyelinating plaques of the optic nerve, most frequently in the retrobulbar space. After an acute episode, 90% of patients regain their vision over 2 to 6 months.

4. Movement and coordination problems

Why? The destruction of oligodendrocytes, the demyelination and the reactive astrogliosis creating the sclerotic plaques in the central nervous system lead to the impairment of neural conduction. Symptoms depend on the localization of the sclerotic lesions in the central nervous system.

Corticospinal pathway

Cerebellar symptoms

Paraplegia / Paraparesis

Spinal cord lesion

Nystagmus, consequent blurred vision

Lesions in the cerebellar pathways arising from the flocculonodular lobe

Spasticity

Upper motor neuron lesion

Vertigo

Anaconda-sign = MS-hug

(thoracic & abdominal spasticity)

Unstable walking, broad-based gait

Plantar reflex

Upper motor neuron lesion constituting damage to the corticospinal tract

Truncal and limb ataxia

Lesions in the pathways from the spinocerebellum

Hyperreflexia OR

Under the lesion of the spinal cord

Slurred speech

Lesions in the pathways originating from the cerebrocerebellum

Hypo-/areflexia

Lesions interrupting the reflex arc at a segmental level

Hypotonia


5. Heat sensitivity aka. Unthoff-phenomenon

Why? The patient’s symptoms temporarily worsen when their body temperature rises.  It is the result of the conduction block developing in the neural pathways as the body temperature increases. This point of conduction block is reached at a much lower temperature in demyelinated nerves.

6. Bladder incontinence & bowel dysfunction

Why? Sclerotic lesions in the spinal cord affecting the parasympathetic nerves or cutting off the coordinating pathways from the pontine centers result in ineffective bladder contractility, uninhibited contractions and incomplete voiding, also causing constipation.  

7. Cognitive impairment

Why? True dementia is rare among MS patients, but according to the neuropsychological tests, 70% of them have some cognitive impairment. Depression in MS patients is a major problem, too.

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After learning the basics, test your knowledge in practice by solving the MS Day Challenge in InSimu Patient app! You can download it for iOS or Android.

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Sources:

https://www.uptodate.com/contents/clinical-features-of-multiple-sclerosis-in-adults?search=multiple%20sclerosis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3#H392245186
https://www.uptodate.com/contents/image?imageKey=NEURO%2F61789&topicKey=NEURO%2F96029&search=multiple%20sclerosis&rank=1~150&source=see_link
https://www.msif.org/about-ms/symptoms-of-ms/
https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms
https://emedicine.medscape.com/article/1146199-overview?pa=%2BDa9UQS8vwGbxzSl7Z%2FvxZUXQCBj4bkrDHuoWR68lS0ItElW9QHaCAe%2FEBwtVSwKX8MwC0EECwzp432Skuf9qw%3D%3D