Pathogenesis
Risk Factors for Multiple Sclerosis
- Female sex
- Family history of multiple sclerosis
- High lattitude (further from equator)
- EBV infection
- Smoking
Manifestations
Clinical Phenotypes
- Clinically isolated syndrome - a single episode of symptoms
- Relapsing-remitting - relapses with improvement between episodes
- Primary progressive - progression without relapses
- Secondary progressive - progressive disability with fewer relapses and no return to baseline between episodes
Diagnosis
Signs of Multiple Sclerosis
- Signs of optic neuritis - reduced visual acuity, central visual loss, optic disc atrophy
- Internuclear ophthalmoplegia - inability to adduct one eye, with nystagmus in the other eye
- Lhermitte's sign - electric sensation in the limbs on neck flexion
- Upper motor neuron weakness - increased tone, reduced power, hyperreflexia
- Dorsal column (vibration / proprioception) sensory loss
- Signs of cerebellar involvement - ataxia, dysarthria, dysmetria, dysdiadochokinesis, nystagmus
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