Multiple sclerosis is an immune disease that damages the myelin covering of nerves in the brain, optic nerves and spinal cord. It often starts in young adults with attacks that come and go, separated in time and in location.
Key symptoms
- Painful vision loss in one eye (optic neuritis)
- Numbness, tingling or weakness in the limbs
- Double vision or vertigo
- Fatigue and heat sensitivity
- Bladder urgency or trouble with balance
What you find on exam
- Visual acuity and a relative afferent pupillary defect
- Increased reflexes, spasticity or a Babinski sign
- Sensory level or loss of vibration sense
- Coordination and gait
Tests
- MRI brain and spine with contrast: white matter lesions
- Lumbar puncture: oligoclonal bands
- Vitamin B12, thyroid and other tests to rule out mimics
- Visual evoked potentials in selected cases
Treatment basics
- High-dose methylprednisolone for acute relapses
- Disease-modifying therapy such as ocrelizumab, natalizumab or dimethyl fumarate
- Symptom care: baclofen for spasticity, bladder management
- Physical therapy and fatigue management
Red flags
- New weakness of both legs or bladder retention
- Rapid vision loss
- Trouble swallowing or breathing
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.