What are the signs and symptoms of Multiple Sclerosis (MS)?

Signs and Symptoms of Multiple Sclerosis (MS)

Multiple sclerosis typically presents in young adults (20-30 years) with unilateral optic neuritis, partial myelitis, sensory disturbances, or brainstem syndromes such as internuclear ophthalmoplegia developing over several days. 1

Common Presenting Symptoms

• Neurological symptoms:

  • Numbness and tingling (paresthesia)
  • Weakness in limbs
  • Visual impairment (often unilateral)
  • Loss of balance and coordination
  • Dizziness
  • Urinary bladder urgency
  • Fatigue
  • Depression 2

• Visual disturbances:

  • Optic neuritis (characterized by unilateral vision loss with pain on eye movement)
  • Internuclear ophthalmoplegia (failure of ipsilateral eye adduction and contralateral eye abduction nystagmus)
  • Abnormalities of gaze, saccades, pursuit, and nystagmus 3

Disease Patterns

• Relapsing-remitting MS (RRMS):

  • Approximately 85% of cases
  • Characterized by relapses at onset with stable neurologic disability between episodes 4

• Primary-progressive MS (PPMS):

  • Approximately 15% of cases
  • Characterized by progressive neurological damage rather than relapses and remissions 4

Pathophysiological Features

• Primary pathological hallmark: Multiple focal demyelinating lesions in both cerebral white and gray matter
• Brain volume loss can occur even in early stages
• Active inflammation evidenced by contrast-enhancing lesions on MRI 4

Diagnostic Findings

• MRI findings:

  • Periventricular lesions abutting lateral ventricles ("Dawson's fingers")
  • Juxtacortical lesions touching or within the cortex
  • Infratentorial lesions in brainstem and cerebellum
  • Spinal cord lesions (typically cigar-shaped on sagittal views)
  • Gadolinium-enhancing lesions indicating active inflammation 4

• Laboratory findings:

  • CSF-specific oligoclonal bands
  • Elevated IgG index
  • Lymphocytic pleocytosis less than 50/mm³ 4, 1

Less Common Manifestations

• Cognitive impairment
• Spasticity
• Sexual dysfunction
• Pain syndromes
• Emotional lability
• Heat sensitivity 1, 2

Important Clinical Considerations

• MS affects women approximately three times more frequently than men 1
• Symptoms may worsen temporarily with increased body temperature (Uhthoff phenomenon)
• Symptoms can vary widely between patients and even within the same patient over time
• Early diagnosis is crucial as disease-modifying therapies can reduce relapse rates by 29-68% 1

Diagnostic Pitfalls

• MS must be differentiated from other conditions that can mimic its presentation:

  • Vascular disease
  • Spinal cord compression
  • Vitamin B12 deficiency
  • CNS infections (e.g., Lyme disease, syphilis)
  • Other inflammatory conditions (e.g., neuromyelitis optica, sarcoidosis, lupus) 2, 5

• Diagnosis requires evidence of lesions disseminated in both time and space, with no better explanation for symptoms 4, 5

Remember that MS symptoms can be highly variable between individuals, and the pattern and progression of symptoms may change over time. Early recognition of these signs and symptoms is essential for prompt diagnosis and treatment initiation.