Multiple Sclerosis

Your Path

  • Multiple Sclerosis


  • Central Nervous System (Brain and Spinal Cord)


  • Autoimmune, with contribution from genetic and environmental factors
  • Causes inflammation, demyelnation and inury to affected areas

Risk Factors

  • White>black
  • Women>men
  • Age onset typically <40


  • Sub-acute
  • Waxes/wanes
  • Fatigue
  • Affects spinal cord and brain, in a patchy fashion; presentations are highly variable
  • Progresses over year/decades
  • Patchy sensory and motor deficits that can affect any of the neuro pathways and don't follow an anatomic pattern
  • Most common presentations include: optic neuritics (variable degrees of visual loss, 90% one eye, pain with eye movement, double vision, impaired color vision); myelitis (cord: partial sensory or motor symptoms below affected level, shock-like sensation traveling down spine or limbs provoked by neck movement, urinary retention or frequency), brainstem (eye movement problems causing diplopia, sensation jerking visual fields) and cerebellar lesions (imbalance, dizziness/vertigo)
  • Often symptoms occur intermitently, with flares/relapses for days to weeks or months, and then may improve
  • Symptoms can relapse and remit (85% of cases) w/episodic flairs and then recovery (to some degree); primary progressive (later age onset, progression w/o remission); secondary progressive
  • Often worsened with elevations in temperature (e.g. infection)
  • Sometimes band like sensation around abdomen or chest
  • Sometimes cognitive dysfunction

Physical Exam Findings

  • Objective findings that document CNS based dysfunction
  • Can be sensory, motor, optic, cerbellar, brain stem or cranial nerves
  • Eye findings can include: decline in acuity (usually one eye), visual field deficits, afferent pupillary defect, impaired extraoccular movement, impaired color vision, optic nerve edema
  • Motor: focal weakness; doesnt usually affect whole cord, so findings are patchy; affected muscles initially flacid and then spasticity if dont recover
  • Sensory: Decreased sensation, affecting same distribution as motor findings; doesnt usually affect whole cord, so decreased sensation is patchy
  • Cerbebellar: ataxia, impaired fine motor (e.g. finger to nose)
  • Brainstem: impaired extra-occular movements, nystagmus