Symptoms of MS vary from common problems such as unexplained difficulty in walking (occurring in about half of patients at the very beginning) to those that are relatively less common, such as blurred vision, to truly uncommon symptoms such as repeated sudden and brief spasms in one or more limbs (paroxysmal dystonia).
Optic neuritis (retrobulbar neuritis)
an inflammation of the optic nerve with pain and variable loss of vision. Most patients will eventually be diagnosed as having MS.
Despite the many different medical problems that can cause walking difficulty, the experienced neurologist assumes that a young person using a cane most likely has MS. Also, when someone is diagnosed with optic neuritis (or retrobulbar neuritis), we know that the vast majority of patients will be diagnosed with MS within 15 years. Approximately half of those affected by optic neuritis will have another episode of neurologic difficulty within a year. If they see an experienced neurologist, they will then be diagnosed with "clinically definite MS."
There are so many different symptoms of MS that it is almost meaningless to list them. Nevertheless, almost all of these difficulties can occur in other neurologic diseases. It is the relapsing-remitting character of symptoms that is the best evidence that any particular neurologic manifestation is caused by MS. The appearance of neurologic problems such as difficulty in walking (i.e., the "attack") followed by improvement (i.e., the "remission") is what characterizes MS in the typical patient.
A neurologist is required to make a diagnosis of MS, but the diagnosis may be difficult in some patients. In the past, the diagnosis of MS was usually delayed for many years. Two decades ago, the typical delay in diagnosis in the United States was 7 years or more, and in the United Kingdom, it was up to 11 years. This should not happen in this day and age.
Difficulty walking is the most commonly recognized difficulty in MS when first seen by a physician and occurs in about half of the patients at the outset of their illness. This is often due to mild weakness or stiffness of one leg, although sometimes both legs are affected. It is rather common to have the difficulty appear during more prolonged physical activity and particularly with heat exposure. Both raise body temperature and bring out symptoms in MS. Balance problems may also present as gait difficulty.
Actually, numbness and tingling in one or both hands or feet is probably the most common symptom. However, the patient or the physician may not seriously consider them as evidence of illness without other accompanying symptoms. It is general knowledge that otherwise normal people may occasionally have these transient symptoms. A neurologist should investigate if numbness or tingling with or without any other symptom lasts a full day or longer. Recurrent numbness over a period of time is of equal importance.
Difficulties with coordination or the appearance of tremor should always be considered as evidence of nervous system disease and should be investigated. In
Tremor an oscillating rhythmic movement usually involving an extremity. Head movement may accompany tremor but is termed tituba-tion.
Nystagmus fine rhythmic oscillating movements of the eyeball.
Charcot's triad the collection of symptoms includes nystagmus, dysarthria, and tremor (shakey eyes, slurred speech, and shaking of the hands and body) that was described as being characteristic of MS. Although occurring in MS, it is rare.
Glaucoma the disease of the eye characterized by increased intraocular pressure causing damage to the retina and impaired vision.
Trigeminal neuralgia intense, brief, facial pain typically occurring on one side. It is uncommon before 65 years of age, except in MS. Its occurrence in young adults is usually a sign of MS.
the past, some neurologists would not make a diagnosis without the presence of tremor, shaky eyes (nystagmus), and difficulty in speaking, the so-called "Charcot's triad." However, only a minority of patients will ever develop these symptoms; when present, it signals the presence of particularly severe dis-
Although visual problems are less common at onset of illness, they become relatively common over the lifetime of patients with untreated MS. A physician should always evaluate visual symptoms, especially double vision or blurring of vision accompanied by pain in one or both eyes. MS-caused blindness is uncommon. Glaucoma is a more common cause of blindness.
When I thought I had a problem with a tooth, it turned out to be MS. It took the dentist, an x-ray, and my sister's research about trigeminal neuralgia to convince me that the overwhelming pain in my face was MS. When I had a tightness in my chest, it turned out to be MS. It took a heart specialist, my wearing a heart monitor, and several heart exams to reassure my neurologist and my husband that the extra heartbeats were MS. When I lost my vision, it turned out to be MS. When I forgot what year it was, it turned out to be MS. .. and so on.
If I have a new medical problem, it is appropriate to rule out non-MS causes. Sometimes a sore tooth, extra heartbeats, blurry vision, memory lapses, skin growths, and a raspy throat are what they would be for someone without MS. However, more often than not, the new (and some times weird) symptom can be traced to a brain, nerve, or muscle cell that fires, misfires, or stops firing because of MS. With approximately 10 billion brain cells, 45 miles of nerves, and 650 muscles, if something is wrong with me, the odds are that it is MS.
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