Multiple sclerosis - All you really need to know

Consider the diagnosis if any of the following:

• The patient is relatively young
• The symptoms are gradual and come and go (and worse in hot weather / baths - Uthoff phenomenon)
• Unexplained moderate or severe visual disturbance or double vision * with no obvious ocular problem
• Arm/Leg weakness or numbness that 'don't fit' a localised lesion
• Electric shocks in limbs when they bend their head forward (Lhermitte's sign)
• Isolated loss of control of bladder function

It probably isn't MS if:

• They are young school age or post-retirement age
• Symptoms occur rapidly or don't go away
• Higher cortical functions and cognition is affected initially
  

Acute admission is required if new onset:

• visual disturbance
• inability tostand or walk
• loss of sphincter control

otherwise MRI and neurology referral can be done non-urgently

* the classic pathognomonic lesion is optic neuritis on fundoscopy and unilateral internuclear opthalmoplegia (INO)

INO is disruption of the medial longitudinal fasciculus of the brainstem that interconnects CN III, IV, VI governing eye movement. One eye doesn't turn in when looking to the side and the other one develops nystagmus.