MS presents itself with various symptoms…

a bit more about the various MS symtpoms…

  • MS may present in various forms. Some patients have a predominance of cognitive changes, while others present with prominent ataxia, hemiparesis or paraparesis, depression, or visual symptoms. Bipolar disorder and frank dementia may appear late in the disease course, but sometimes are found at the time of initial diagnosis. Symptoms can be exacerbated by intercurrent illness, including viral or bacterial upper respiratory or urinary tract infections. Trauma has no impact on disease exacerbation. The impact of emotional stress on exacerbations is probably minimal and remains controversial.
  • Optic neuritis presents clinically as orbital pain, at rest or during eye movement, and loss of vision. Patients may complain of “patchy loss of vision,” and upon examination, a cecocentral scotoma and an afferent pupillary defect may be found. Patients may experience color desaturation even with normal visual acuity, usually manifested as the perception of red color as different shades of orange or gray.
  • Patients with MS may present with facial palsies or trigeminal neuralgia. In fact, the presence of bilateral facial weakness or trigeminal neuralgia strongly suggests the diagnosis of MS. Facial myokymia also may be a presenting symptom. Nystagmus (direction-changing) and internuclear ophthalmoplegia signs are other manifestations.
  • Painful limb syndromes are important to recognize. Commonly, patients complain of numbness or tingling in one or more limbs, variable weakness, or sensory level-related symptoms. Some have difficulty describing weakness or numbness, as these symptoms are obscured by incapacitating fatigue.
  • Episodes of central (as opposed to peripheral) vertigo are not uncommon. The nystagmus accompanying central vertigo has a rapid onset, does not fatigue easily, and changes with direction of gaze. CNS vertigo usually is accompanied by other complaints that can be directly attributed to brainstem or cerebellar pathway involvement (eg, diplopia, dysarthria).
  • An often overlooked manifestation of MS is the pseudobulbar affect, whereby patients have difficulty controlling their emotions (laughing, crying) and are perceived to act inappropriately by coworkers or friends.
    • Behavioral/cognitive symptoms also may include social disinhibition, dementia, or depression.
    • A greater tendency for attempting and committing suicide in MS is not related exclusively to a reactive depression, since this tendency is higher than that of patients with other devastating neurological disorders such as chronic inflammatory demyelinating polyradiculopathy (CIDP).
    • The neurologist should be aware that patients with conversion reactions and inappropriate affect, such as “la belle indifference,” may on occasion have an underlying organic illness such as MS.
  • Urinary retention and incontinence are common. Bowel habit changes may occur, but bowel incontinence is less frequent.
  • Sexual dysfunction affects the great majority of patients with MS and includes symptoms such as lack of desire, erectile dysfunction, impaired sexual responsiveness, premature ejaculation, impaired genital sensation, or inability to physically interact with the partner due to painful leg adductor muscle spasms.

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