Clinical features

• more common in females

• peak age of onset is in the fourth decade

• transient motor and sensory disturbances

• upper motor neurone signs

• symptoms develop over several days but can be sudden

• monosymptomatic initially in about 80%

• multiple symptoms initially in about 20%

• common initial symptoms include:

o visual disturbances of optic neuritis

■ blurred vision or loss of vision in one eye (sometimes both)

■ central scotoma with pain on eye movement (looks like unilateral papilloedema) o diplopia (brainstem lesion)

o weakness in one or both legs, paraparesis or hemiparesis o sensory impairment in the lower limbs and trunk

■ numbness, paraesthesia

■ band-like sensations

■ clumsiness of limb (loss of position sense)

■ feeling as though walking on cotton wool o vertigo (brainstem lesion)

• subsequent remissions and exacerbations that vary from one individual to another

• there is a progressive form especially in women around 50 years

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