Multiple sclerosis physical examination: Difference between revisions
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Physical examination of patients with multiple sclerosis is usually remarkable for: | Physical examination of patients with multiple sclerosis is usually remarkable for: | ||
=== | === Appearance of the Patient === | ||
* Gait and balance disturbance | |||
==== Lhermitte's Sign | Involvement of [[cerebellar]] tracts can cause [[Gait]] and balance problems in multiple sclerotic patients.<ref name="pmid25573524">{{cite journal |vauthors=Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR |title=Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey |journal=BMJ Open |volume=5 |issue=1 |pages=e006714 |date=January 2015 |pmid=25573524 |pmc=4289717 |doi=10.1136/bmjopen-2014-006714 |url=}}</ref> | ||
=== Neuromuscular === | |||
* 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's 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's 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 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 ophthalmoplegia|INO]]) is defined as a gaze problem. Lesions in [[medial longitudinal fasciculus]] in [[brain stem]] are known to be the cause of [[Internuclear ophthalmoplegia|INO]].<ref name="pmid11552000">{{cite journal |vauthors=Frohman EM, Zhang H, Kramer PD, Fleckenstein J, Hawker K, Racke MK, Frohman TC |title=MRI characteristics of the MLF in MS patients with chronic internuclear ophthalmoparesis |journal=Neurology |volume=57 |issue=5 |pages=762–8 |date=September 2001 |pmid=11552000 |doi= |url=}}</ref> The signs of [[Internuclear ophthalmoplegia|INO]] are difficulty with [[Adduction|adducting]] in lateral gaze. For compensation of these problems, the contra lateral eye will have [[nystagmus]] leading to [[diplopia]]<ref name="pmid18678831">{{cite journal |vauthors=Mills DA, Frohman TC, Davis SL, Salter AR, McClure S, Beatty I, Shah A, Galetta S, Eggenberger E, Zee DS, Frohman EM |title=Break in binocular fusion during head turning in MS patients with INO |journal=Neurology |volume=71 |issue=6 |pages=458–60 |date=August 2008 |pmid=18678831 |doi=10.1212/01.wnl.0000324423.08538.dd |url=}}</ref> or [[vertigo]].<ref name="pmid15136670">{{cite journal |vauthors=Kim JS |title=Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction |journal=Neurology |volume=62 |issue=9 |pages=1491–6 |date=May 2004 |pmid=15136670 |doi= |url=}}</ref> | [[Internuclear ophthalmoplegia]] ([[Internuclear ophthalmoplegia|INO]]) is defined as a gaze problem. Lesions in [[medial longitudinal fasciculus]] in [[brain stem]] are known to be the cause of [[Internuclear ophthalmoplegia|INO]].<ref name="pmid11552000">{{cite journal |vauthors=Frohman EM, Zhang H, Kramer PD, Fleckenstein J, Hawker K, Racke MK, Frohman TC |title=MRI characteristics of the MLF in MS patients with chronic internuclear ophthalmoparesis |journal=Neurology |volume=57 |issue=5 |pages=762–8 |date=September 2001 |pmid=11552000 |doi= |url=}}</ref> The signs of [[Internuclear ophthalmoplegia|INO]] are difficulty with [[Adduction|adducting]] in lateral gaze. For compensation of these problems, the contra lateral eye will have [[nystagmus]] leading to [[diplopia]]<ref name="pmid18678831">{{cite journal |vauthors=Mills DA, Frohman TC, Davis SL, Salter AR, McClure S, Beatty I, Shah A, Galetta S, Eggenberger E, Zee DS, Frohman EM |title=Break in binocular fusion during head turning in MS patients with INO |journal=Neurology |volume=71 |issue=6 |pages=458–60 |date=August 2008 |pmid=18678831 |doi=10.1212/01.wnl.0000324423.08538.dd |url=}}</ref> or [[vertigo]].<ref name="pmid15136670">{{cite journal |vauthors=Kim JS |title=Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction |journal=Neurology |volume=62 |issue=9 |pages=1491–6 |date=May 2004 |pmid=15136670 |doi= |url=}}</ref> | ||
* Optic Neuritis | |||
[[Optic neuritis]] can be the first [[Medical sign|sign]] of multiple sclerosis, especially when it’s accompanied by [[white matter]] [[MRI]] [[lesions]].<ref>{{cite journal |author=Beck RW, Trobe JD |title=What we have learned from the Optic Neuritis Treatment Trial|journal=Ophthalmology |volume=102 |issue=10 |pages=1504-8 |year=1995 |pmid=9097798}}</ref><ref>{{cite journal |author= |title=The 5-year risk of MS after optic neuritis: experience of the optic neuritis treatment trial. 1997 |journal=Neurology |volume=57|issue=12 Suppl 5 |pages=S36-45 |year=2001 |pmid=11902594}}</ref> | |||
[[Optic neuritis]] can be the first [[Medical sign|sign]] of multiple sclerosis, especially when it’s accompanied by [[white matter]] [[MRI]] [[lesions]].<ref>{{cite journal |author=Beck RW, Trobe JD |title=What we have learned from the Optic Neuritis Treatment Trial|journal=Ophthalmology |volume=102 |issue=10 |pages=1504-8 |year=1995 |pmid=9097798}}</ref><ref>{{cite journal |author= |title=The 5-year risk of MS after optic neuritis: experience of the optic neuritis treatment trial. 1997 |journal=Neurology |volume=57|issue=12 Suppl 5 |pages=S36-45 |year=2001 |pmid=11902594 | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Irfan Dotani
Overview
Physical examination of patients with multiple sclerosis is usually remarkable for lhermitte's sign, spasticity, increased reflexes, internuclear ophthalmoplegia, optic neuritis, and gait disturbance.
Physical Examination
Physical examination of patients with multiple sclerosis is usually remarkable for:
Appearance of the Patient
- Gait and balance disturbance
Involvement of cerebellar tracts can cause Gait and balance problems in multiple sclerotic patients.[1]
Neuromuscular
- 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's sign can correlate with MRI abnormalities of caudal medulla or cervical dorsal columns. .[2][3][4][5]
- 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.[6]
- Internuclear Ophthalmoplegia
Internuclear ophthalmoplegia (INO) is defined as a gaze problem. Lesions in medial longitudinal fasciculus in brain stem are known to be the cause of INO.[7] The signs of INO are difficulty with adducting in lateral gaze. For compensation of these problems, the contra lateral eye will have nystagmus leading to diplopia[8] or vertigo.[9]
- Optic Neuritis
Optic neuritis can be the first sign of multiple sclerosis, especially when it’s accompanied by white matter MRI lesions.[10][11]
References
- ↑ Rinker JR, Salter AR, Walker H, Amara A, Meador W, Cutter GR (January 2015). "Prevalence and characteristics of tremor in the NARCOMS multiple sclerosis registry: a cross-sectional survey". BMJ Open. 5 (1): e006714. doi:10.1136/bmjopen-2014-006714. PMC 4289717. PMID 25573524.
- ↑ 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.
- ↑ Al-Araji AH, Oger J (2005). "Reappraisal of Lhermitte's sign in multiple sclerosis". Mult. Scler. 11 (4): 398–402. PMID 16042221.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Frohman EM, Zhang H, Kramer PD, Fleckenstein J, Hawker K, Racke MK, Frohman TC (September 2001). "MRI characteristics of the MLF in MS patients with chronic internuclear ophthalmoparesis". Neurology. 57 (5): 762–8. PMID 11552000.
- ↑ Mills DA, Frohman TC, Davis SL, Salter AR, McClure S, Beatty I, Shah A, Galetta S, Eggenberger E, Zee DS, Frohman EM (August 2008). "Break in binocular fusion during head turning in MS patients with INO". Neurology. 71 (6): 458–60. doi:10.1212/01.wnl.0000324423.08538.dd. PMID 18678831.
- ↑ Kim JS (May 2004). "Internuclear ophthalmoplegia as an isolated or predominant symptom of brainstem infarction". Neurology. 62 (9): 1491–6. PMID 15136670.
- ↑ Beck RW, Trobe JD (1995). "What we have learned from the Optic Neuritis Treatment Trial". Ophthalmology. 102 (10): 1504–8. PMID 9097798.
- ↑ "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.