Multiple sclerosis physical examination

Physical examination of patients with multiple sclerosis is usually remarkable for lhermitte’s sign, spasticity, increased reflexes, internuclear ophthalmoplegia, optic neuritis, gait disturbance, and urinary incontinence.

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

• Gait and balance disturbance: Involvement of cerebellar tracts can cause Gait and balance problems in multiple sclerotic patients.^[1]

• We may see positional change in blood pressure and heart rate due to autonomic dysfunction.^[2]

• Skin examination of patients with multiple sclerosis is usually normal.

• 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. The signs of INO are difficulty with adducting in lateral gaze.^[3][4][5]

• Optic Neuritis: Optic neuritis can be the first sign of multiple sclerosis, especially when it’s accompanied by white matter MRI lesions.^[6][7]
• Nystagmus
• Diplopia
• Extra-ocular movements may be abnormal
• Facial pain
• Hearing loss

• Neck examination of patients with multiple sclerosis is usually normal.

• Pulmonary examination of patients with multiple sclerosis is usually normal.

• Cardiovascular examination of patients with multiple sclerosis is usually normal.

• Abdominal examination of patients with multiple sclerosis is usually normal.

• Back examination of patients with multiple sclerosis is usually normal.

• Urinary incontinence

• Erectile dysfunction
• Vaginal dryness

• 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.^{[8][9][10][11][12]}
• Spasticity (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).

• Patient is usually oriented to persons, place, and time
• Hyperreflexia
• Positive (abnormal) Babinski
• Proximal/distal muscle weakness unilaterally/bilaterally
• Unilateral or bilateral sensory loss in the upper/lower extremity
• Abnormal gait
• Positive Trendelenburg sign
• Tremor
• Dysmetria

• Tremor
• Muscle spasm
• Weakness

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