Last reviewed: June 2019
Last updated: February  2019

Summary

Definition

History and exam

Key diagnostic factors

  • visual disturbance in one eye
  • peculiar sensory phenomena

Other diagnostic factors

  • female
  • age 20 to 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 disk or noncorrectable visual loss
  • incorrect responses to Ishihara color blindness test plates
  • abnormal eye movements

Risk factors

  • female sex
  • genetic factors
  • northern latitude
  • smoking
  • vitamin D deficiency
  • autoimmune disease
  • Epstein-Barr virus (EBV)

Diagnostic investigations

1st investigations to order

  • MRI - brain
  • MRI - spinal cord
  • CBC
  • comprehensive metabolic panel
  • thyroid-stimulating hormone
  • vitamin B12
Full details

Investigations to consider

  • anti-neuromyelitis optica antibody
  • cerebrospinal fluid evaluation
  • evoked potentials
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Staff Neurologist

Mellen Center for MS Treatment and Research

Neurological Institute

Cleveland Clinic Foundation

Cleveland

OH

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 VIEW ALL

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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