Summary
Definition
History and exam
Key diagnostic factors
- visual disturbance in one eye
- peculiar sensory phenomena
Other diagnostic factors
- female sex
- age 20-40 years
- foot dragging or slapping
- leg cramping
- fatigue
- urinary frequency
- bowel dysfunction
- spasticity/increased muscle tone
- increased deep tendon reflexes
- imbalance/incoordination
- pale optic disc or non-correctable visual loss
- incorrect responses to Ishihara colour blindness test plates
- abnormal eye movements
Risk factors
- female sex
- northern latitude
- genetic factors
- smoking
- vitamin D deficiency
- autoimmune disease
- Epstein-Barr virus (EBV)
Diagnostic investigations
1st investigations to order
- MRI - brain
- MRI - spinal cord
- FBC
- comprehensive metabolic panel
- thyroid-stimulating hormone
- vitamin B12
Investigations to consider
- anti-neuromyelitis optica antibody
- cerebrospinal fluid evaluation
- evoked potentials
Treatment algorithm
Contributors
Authors
Associate Professor and Chair
Department of Neurology
University of Mississippi Medical Center
Jackson
MS
Disclosures
MAW has received payment for participating on the speakers' bureaus of Biogen, Genzyme, and Novartis. MAW also serves on the editorial board for the International Journal of MS Care.
Dr Mary Alissa Willis would like to gratefully acknowledge Dr Lael A. Stone, a previous contributor to this topic. LAS declares that she has no competing interests.
Peer reviewers
Project Leader for Neurology
Neurological Institute
Cleveland Clinic
Cleveland
OH
Disclosures
ARG declares that he has no competing interests.
Associate Professor of Neurology
Department of Clinical Neurological Sciences
London Health Sciences Centre
University Hospital
Ontario
Canada
Disclosures
SAM declares that she has no competing interests.
Director
The London Multiple Sclerosis Clinic
Associate Professor
Schulich School of Medicine
University of Western Ontario
Neurologist
Clinical Neurological Sciences Department
University Hospital
London Health Sciences Centre
Ontario
Canada
Disclosures
MK declares that he has no competing interests.
Consultant Neurologist
Department of Neurology
Queen’s Hospital
Romford
UK
Disclosures
AC declares that he has no competing interests.
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