Subtypes

RRMS most common, PPMS hardest to treat

• CIS: Clinically isolated syndrome (not = MS)
• RIS: Radiologically isolated syndrome

Risk Factors

EBV (HHV 4)

Smoking (RF)

Lack of sun exposure → Should take Vitamin D Supplement

Presentation

• Neurological symptoms with
  • hours to days onset (gradual)
  • lasting at least 24 hours
  • no associated with fever or infection
• Characteristic symptoms
  • Eye
    • Optic neuritis (ipsolateral)
    • Diplopia → INO - Intranuclear ophthalmoplegia , can be bilateral
      • Or other ocular palsy
  • Spine → !Myelopathy (”Transverse Myelitis”)
    • Sensory symptom (most common)
    • Muscle Weakness with UMN signs
    • lhermitte sign (cervical DC)
    • Band-like sensation (Thoracic DC)
    • !BBD
  • Brainstem
    • Facial weakness/paralysis
    • Trigeminal neuralgia
    • Vertigo, Nystagmus
  • Cerebellar → Ataxia
  • Other common symptom
    • Fatigue
    • Depression Symptom and Anxiety Symptoms
    • Uhthoff's phenomenon
    • Cognitive impairment
    • RLS - Restless Legs Syndrome
    • Sleep Problem
• Pertinent negative: MS typically has no cortical signs (ex. aphasia) in the early phases

Mimickers

• NMO - Neuromyelitis Optica Spectrum Disorder
• MOGAD - Anti-MOG Ab Disease
• Autoimmune Encephalitis

MS DDx

Investigation

1. Brain MRI (T2 FLAIR and T1 with Gd (MRI W/ Contrast) )