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Mutiple Sclerosis: Clinical Features, Epidemiology, Pathology, Location of Lesions

by Carlo Raj, MD
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    Multiple sclerosis. So, how do we begin? How do you know? You’re reading a chart of a patient, you’re reading a clinical vignette. How do you know the patient has multiple sclerosis? Things that you will be paying attention to immediately, unilateral visual impairment. Once again, I emphasized unilateral visual impairment, and this is due to optic neuritis. And so whenever you’ve heard the team optic neuritis, you should then translate into the patient having difficulty with vision. Or retrobulbar neuritis is frequently the initial manifestation. Now, we have to understand in clinical practice, you could have variants all the time, and I’ll walk you through a few of those, but at some point in time, we have to know as to what is the most common presentation. Cranial nerve signs: you could have ataxia, nystagmus. And then at some point in time, the eyes, both of them, start moving back and forth, back and forth, back and forth maybe. And at that point, you might be thinking about lesion to the internuclear ophthalmoplegia. Please pay attention to internuclear ophthalmoplegia. It’s a disorder of conjugate lateral gaze from interruption of fibers of the medial longitudinal fasciculus. INO, internuclear ophthalmoplegia; MLF, medial longitudinal fasciculus. Those are some clinical pearls there that you want to pay attention to. Spinal cord lesions, spasticity and urinary incontinence could also be part of the syndrome. But pay attention to, firstly, what is the initial presentation, and you’re paying attention to different behaviors of the eyes, huh? Visual impairment, optic neuritis, nystagmus or the conjugate gaze type of issue, and that’s your internuclear ophthalmoplegia. Let’s move on. Other clinical features that you want to keep in mind. One is called Lhermitte’s sign. It’s a shock-like sensation that goes up and down the spine from the neck,...

    About the Lecture

    The lecture Mutiple Sclerosis: Clinical Features, Epidemiology, Pathology, Location of Lesions by Carlo Raj, MD is from the course Multiple Sclerosis. It contains the following chapters:

    • Multiple Sclerosis: Clinical features
    • Multiple Sclerosis: Epidemiology
    • Multiple Sclerosis: Pathology
    • Multiple Sclerosis: Location of Lesions

    Included Quiz Questions

    1. Lhermitte sign
    2. Uhthoff sign
    3. Angoff sign
    4. Sunset sign
    5. Kernig sign
    1. Medial longitudinal fasciculus
    2. Lateral longitudinal fasciculus
    3. Medial dorsal column
    4. Lateral dorsal column
    5. Red nucleus
    1. Argyle Robertson pupil
    2. Intranuclear ophthalmoplegia
    3. Nystagmus
    4. Optic neuritis
    5. Retrobulbar neuritis
    1. Pituitary gland
    2. Medulla
    3. Around the 4th ventricle
    4. T5 to T10 spinal cord segment
    5. 2nd cranial nerve
    1. Around the ventricles
    2. Around the arteries
    3. Around the veins
    4. Around the tracts
    5. Around the horns

    Author of lecture Mutiple Sclerosis: Clinical Features, Epidemiology, Pathology, Location of Lesions

     Carlo Raj, MD

    Carlo Raj, MD


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