Multiple Sclerosis
Background:
Signs & Symptoms:
Treatment:
Special Tests:
- Multiple sclerosis (MS) is a chronic neurological disease that results in demyelination of the myelin sheath that leads to scars or lesions in different locations within the central nervous system. It is a continual inflammatory demyelinating disorder of either the axons or the oligodendrocytes. MS is a multifactorial disease that is caused by both genetic and environmental features (Shaygannejad & Tolou-Ghamari, 2013). There are many different types of MS which creates a large variability in disease progression and symptoms. The symptoms that occur depend on the site and rigor of the lesion. Individual treatment should take individual prognosis into account (Heese, Gaissmaier, & Daumer, 2013).
Signs & Symptoms:
- May develop vertigo as initial disease manifestation or during the course of the illness (Pula, Newman-Toker & Kattah, 2013).
- Signs with associated lesion localization with MRI findings: (Pula, Newman-Toke & Kattah, 2013)
- Unidirectional right-beating horizontal-torsional nystagmus, grade 2. Eye movement recording showed jerk right-beating nystagmus at 2 Hz. Lesions at right infero-antero-medial cerebellum near inferior cerebellar peduncle junction
- Acute symptoms of vertigo fall into two major categories; acute vestibular syndrome (AVS) and positional vertigo. AVS differs from benign paroxysmal positional vertigo because it is a single, prolonged, spontaneous episode of acute vertigo or dizziness lasting days to weeks, coupled with nausea or vomiting, nystagmus, head motion intolerance and gait disturbances (Pula, Newman-Toker & Kattah, 2013)
- Seesaw nystagmus. Lesion: Right Medial Longitudinal Fasciculus
- Direction-changing, bilateral horizontal gaze evoked nystagmus. Left ocular tilt reaction with right hypertropia and ocular torsion. Partial left abducens palsy. Facial, tongue numbness. Lesion: Left middle cerebellar peduncle with satellite lesion extending to pontine 8th nerve fascicle
- Upbeat nystagmus, worse in down gaze. Lesion: Medulla
- Unidirectional, right-beating horizontal-torsional nystagmus, grade 2. Lesion: Left pontine tegmentum in the 8th nerve fascicle
- Direction-changing bilateral horizontal gaze-evoked nystagmus with a downbeat vertical component. Left ocular lateropulsion. Lesion: left periventricular pontine: adjacent to vestibular nuclei near superior cerebellar peduncle
- AVS- demyelinating plaques in and around the 8th nerve fascicle or vestibular nuclei and is more likely to reoccur. There may also be active lesions near the fourth ventricle. Interruption of otolithic projections in the superior cerebellar peduncle connecting the fastigial nucleus to the vestibular nuclei has been postulated as the underlying mechanism (Pula, Newman-Toker & Kattah, 2013).
- Lesions causing AVS were found in various posterior fossa locations including all three levels of the brainstem and in each of the three cerebellar peduncles (Pula, Newman-Toker & Kattah, 2013).
- Oculomotor signs are the most prominent clinical features (Pula, Newman-Toker & Kattah, 2013).
- Most common cause of AVS in MS is due to a lesion in the lower pons or upper medulla affecting either the vestibular nucleus or the fascicular portion of the eight nerve (Pula, Newman-Toker & Kattah, 2013).
Treatment:
- Medication for the demyelinating condition (Pula, Newman-Toker & Kattah, 2013).
- Vestibular rehabilitation has been found to help with these type of central conditions (Pula, Newman-Toker & Kattah, 2013).
Special Tests:
- HINTS examination (See Special Test tab)