The 60 faces of multiple sclerosis

Multiple sclerosis (MS) dominates neurological practice in many parts of the world. This is no doubt because it is a common disorder which favours the young.The typical form, relapsing remitting MS (RRMS), is often easy to recognise and diagnose. The are however other types and variants such as primary progressive MS (PPMS), which often pose a challenge to neurologists to pin down.

 

MRI scan. NIH Image Gallery on Flikr. https://www.flickr.com/photos/nihgov/30805879596

There is no single clinical symptom or sign that is pathognomonic of MS. Some presentations are red flags for MS, such as optic neuritis (ON) and transverse myelitis (TM). Many other MS symptoms and syndromes are however non-specific. The ways MS presents are diverse, and below is a list of the 50 different faces of MS. If you want to explore any of these, you will find links to our extensive MS and other neuroinflammatory checklists at the end of the blog post.

 

Link

Ophthalmological features

Optic neuritis

Diplopia 

Nystagmus

Internuclear ophthalmoplegia (INO) 

Uhthoff’s phenomenon

Pulfrich phenomenon

Horner’s syndrome

 

Movement disorders

Ataxia

Tremor

Tonic spasms

Restless legs syndrome

Paroxysmal kinesigenic dyskinesia (PKD)

Periodic limb movement disorder (PLMD)

Propriospinal myoclonus

 

Cerebral features

Memory impairment

Executive dysfunction

Encephalopathy

Seizures

Sleep disorders

Foreign accent syndrome

Headache

 

Cranial nerve disorders

Trigeminal neuralgia

Olfactory dysfunction

Taste dysfunction

 

Neuro-otological features

Vertigo

Dizziness

Hyperacusis

 

Autonomic and endocrine features

Incontinence

Constipation

Impaired libido

Erectile dysfunction

Male infertility

Panhypopituitarism

 

Bulbar and pseudobulbar features

Dysphagia

Dysarthria

Pathological laughter

Pathological crying

 

Spinal cord features

Transverse myelitis (TM)

Spastic paraparesis

Lhermitte’s phenomenon 

 

Neuropsychiatric features

Depression

Psychosis

 

Sensory and temperature disturbances

Pain

Sensory impairment

Paroxysmal attacks

Radicular symptoms

Heat sensitivity

Episodic hypothermia

 

Sleep-related disorders

Excessive daytime sleepiness (EDS)

Insomnia

Sleep-related breathing disorder (SRBD)

Secondary narcolepsy

REM sleep behaviour disorder

 

Systemic features

Respiratory impairment

Neurogenic pulmonary oedema

Takotsubo cardiomyopathy 

Neurogenic stunned myocardium

Myocardial infarction

Fatigue

 

MS variants

Tumefactive MS

Balo’s concentric sclerosis

MRI scan. NIH Image Gallery on Flikr. https://www.flickr.com/photos/nihgov/30805878966

***

MS related Neurochecklists 

Classification

Diagnostic criteria

Modifiable risk factors

Non-modifiable risk factors

Typical neurological features

Other neurological features

Paroxysmal attacks

Seizures

Systemic features

Balo’s concentric sclerosis

Tumefactive MS

Differential diagnosis

Poor prognostic factors

Primary progressive multiple sclerosis (PPMS)

Isolated syndromes

Investigations

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