Clinical Presentations In Multiple Sclerosis

A 35-year-old woman presents with a variety of symptoms including generalized skin tingling and headache. She is concerned she may have multiple sclerosis. What is the most common presentation of multiple sclerosis?
A. Tremor
B. Urinary incontinence
C. Optic neuritis
D. Motor neuropathy
E. Internuclear ophthalmoplegia

Answer:
C. Optic neuritis

Discussion: Patient's with multiple sclerosis (MS) may present with non-specific features, for example around 75% of patients have significant lethargy.

Visual Symptoms:
 optic neuritis: common presenting feature
 optic atrophy
 Uhthoff's phenomenon: worsening of vision following rise in body temperature
 internuclear ophthalmoplegia

Sensory symptoms:
  pins/needles
 numbness
 trigeminal neuralgia
 Lhermitte's syndrome: paraesthesiae in limbs on neck flexion

Motor Symptoms:
 spastic weakness: most commonly seen in the legs

 Cerebellar features;
  ataxia: more often seen during an acute relapse than as a presenting symptom
 tremor

Others
 urinary incontinence
 sexual dysfunction
 intellectual deterioration