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About 25-40% of MS patients experience lhermitte’s sign as an electrical shock sensation going downward from neck when the patients neck bends forward. Lhermitte sign can correlate with MRI abnormalities of caudal medulla or cervical dorsal columns. .<ref>{{cite journal |author=Gutrecht JA, Zamani AA, Slagado ED|title=Anatomic-radiologic basis of Lhermitte's sign in multiple sclerosis |journal=Arch. Neurol. |volume=50 |issue=8 |pages=849-51|year=1993 |pmid=8352672 |doi=}}</ref><ref>{{cite journal |author=Al-Araji AH, Oger J |title=Reappraisal of Lhermitte's sign in multiple sclerosis |journal=Mult. Scler.|volume=11 |issue=4 |pages=398-402 |year=2005 |pmid=16042221 |doi=}}</ref><ref>{{cite journal |author=Sandyk R, Dann LC|title=Resolution of Lhermitte's sign in multiple sclerosis by treatment with weak electromagnetic fields |journal=Int. J. Neurosci.|volume=81 |issue=3-4 |pages=215-24 |year=1995 |pmid=7628912 |doi=}}</ref><ref>{{cite journal |author=Kanchandani R, Howe JG|title=Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature |journal=J. Neurol. Neurosurg. Psychiatr. |volume=45 |issue=4 |pages=308-12 |year=1982 |pmid=7077340 |doi=}}</ref>
About 25-40% of MS patients experience lhermitte’s sign as an electrical shock sensation going downward from neck when the patients neck bends forward. Lhermitte sign can correlate with MRI abnormalities of caudal medulla or cervical dorsal columns. .<ref>{{cite journal |author=Gutrecht JA, Zamani AA, Slagado ED|title=Anatomic-radiologic basis of Lhermitte's sign in multiple sclerosis |journal=Arch. Neurol. |volume=50 |issue=8 |pages=849-51|year=1993 |pmid=8352672 |doi=}}</ref><ref>{{cite journal |author=Al-Araji AH, Oger J |title=Reappraisal of Lhermitte's sign in multiple sclerosis |journal=Mult. Scler.|volume=11 |issue=4 |pages=398-402 |year=2005 |pmid=16042221 |doi=}}</ref><ref>{{cite journal |author=Sandyk R, Dann LC|title=Resolution of Lhermitte's sign in multiple sclerosis by treatment with weak electromagnetic fields |journal=Int. J. Neurosci.|volume=81 |issue=3-4 |pages=215-24 |year=1995 |pmid=7628912 |doi=}}</ref><ref>{{cite journal |author=Kanchandani R, Howe JG|title=Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature |journal=J. Neurol. Neurosurg. Psychiatr. |volume=45 |issue=4 |pages=308-12 |year=1982 |pmid=7077340 |doi=}}</ref>


==== spasticity ====
==== Spasticity and increased reflexes ====
Damage to the upper motor neurons and decrease inhibition of lower motor neurons in [[MS]] can increase muscle tone and rigidity in 75% of [[MS]] patients.<ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref>
Damage to the upper motor neurons and decrease inhibition of lower motor neurons in [[MS]] can increase muscle tone and rigidity in 75% of [[MS]] patients.<ref name="pmid17868019">{{cite journal |vauthors=Boissy AR, Cohen JA |title=Multiple sclerosis symptom management |journal=Expert Rev Neurother |volume=7 |issue=9 |pages=1213–22 |date=September 2007 |pmid=17868019 |doi=10.1586/14737175.7.9.1213 |url=}}</ref>


==== Internuclear Ophthalmoplegia ====
==== Internuclear Ophthalmoplegia ====
 
Internuclear ophtalmoplegia (INO) is defined as a gaze problem. Lesions in medial longitudinal fasciculus in brain stem are known to be the cause of INO.
[[Image:Internuclear ophthalmoplegia.jpg|thumb|right|180px|''Schematic demonstrating right internuclear ophthalmoplegia, caused by injury of the right [[medial longitudinal fasciculus]] '']]
{{Main|Internuclear ophthalmoplegia}}
 
Internuclear ophthalmoplegia is a disorder of conjugate lateral gaze. The affected eye shows impairment of [[adduction]].  The partner eye diverges from the affected eye during abduction, producing [[diplopia]]; during extreme abduction, compensatory [[nystagmus]] can be seen in the partner eye. Diplopia means double vision while nystagmus is involuntary [[eye movement]] characterized by alternating [[smooth pursuit]] in one direction and a [[saccadic movement]] in the other direction.
 
Internuclear ophthalmoplegia occurs when MS affects a part of the [[brain stem]] called the [[medial longitudinal fasciculus]], which is responsible for communication between the two eyes by connecting the [[abducens nucleus]] of one side to the [[oculomotor nucleus]] of the opposite side. This results in the failure of the [[medial rectus muscle]] to contract appropriately, so that the eyes do not move equally (called disconjugate gaze).


====Optic Neuritis====
====Optic Neuritis====

Revision as of 14:59, 1 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Physical Examination

Physical examination of patients with multiple sclerosis is usually remarkable for:

Lhermitte's Sign

About 25-40% of MS patients experience lhermitte’s sign as an electrical shock sensation going downward from neck when the patients neck bends forward. Lhermitte sign can correlate with MRI abnormalities of caudal medulla or cervical dorsal columns. .[1][2][3][4]

Spasticity and increased reflexes

Damage to the upper motor neurons and decrease inhibition of lower motor neurons in MS can increase muscle tone and rigidity in 75% of MS patients.[5]

Internuclear Ophthalmoplegia

Internuclear ophtalmoplegia (INO) is defined as a gaze problem. Lesions in medial longitudinal fasciculus in brain stem are known to be the cause of INO.

Optic Neuritis

Optic neuritis can be the first sign of multiple sclerosis especially when it’s accompanied by white matter MRI lesions and is very common among these patients.[6][7]

References

  1. ↑ Gutrecht JA, Zamani AA, Slagado ED (1993). "Anatomic-radiologic basis of Lhermitte's sign in multiple sclerosis". Arch. Neurol. 50 (8): 849–51. PMID 8352672.
  2. ↑ Al-Araji AH, Oger J (2005). "Reappraisal of Lhermitte's sign in multiple sclerosis". Mult. Scler. 11 (4): 398–402. PMID 16042221.
  3. ↑ Sandyk R, Dann LC (1995). "Resolution of Lhermitte's sign in multiple sclerosis by treatment with weak electromagnetic fields". Int. J. Neurosci. 81 (3–4): 215–24. PMID 7628912.
  4. ↑ Kanchandani R, Howe JG (1982). "Lhermitte's sign in multiple sclerosis: a clinical survey and review of the literature". J. Neurol. Neurosurg. Psychiatr. 45 (4): 308–12. PMID 7077340.
  5. ↑ Boissy AR, Cohen JA (September 2007). "Multiple sclerosis symptom management". Expert Rev Neurother. 7 (9): 1213–22. doi:10.1586/14737175.7.9.1213. PMID 17868019.
  6. ↑ Beck RW, Trobe JD (1995). "What we have learned from the Optic Neuritis Treatment Trial". Ophthalmology. 102 (10): 1504–8. PMID 9097798.
  7. ↑ "The 5-year risk of MS after optic neuritis: experience of the optic neuritis treatment trial. 1997". Neurology. 57 (12 Suppl 5): S36–45. 2001. PMID 11902594.

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