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1. Paroxysmal symptoms make up the usual course of early disease (except in chronic progressive cases).

2. Weakness or numbness in 1 or more limbs, tingling of the extremities & tight band-like sensations around the trunk or limbs.

3. Optic neuritis - painful loss of central vision in one or both eyes. With unilateral involvement, Marcus Gunn pupil (RAPD) is evident.

4. Internuclear ophthalmoplegia - lesion of the MLF. Difficulty in moving eyes horizontally (adduction paresis), but convergence is intact.

5. Acute myelitis - rapidly evolving (hours or days) symmetrical or asymmetrical paraparesis or paraplegia, ascending paresthesia, sensory level on the trunk, sphincter disturbance and up-going plantars.

6. Others - fatigue, nebulous sensory abnormalities, vertigo/diplopia, ataxic gait, and bowel/ bladder dysfunction, Lhermitte sign, cognitive impairment.

7. Symptoms worsen in the heat (Uhthoff phenomenon) as heat increases conduction block in demyelinated pathways.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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