Clinical Pearls:Diagnosis of MS
Diagnosing Multiple Sclerosis
[Clinician Reviews 9(7):72, 1999. © 1999 Clinicians Publishing Group and Williams & Wilkins]

Early diagnosis of multiple sclerosis rests solely on a high index of suspicion based on reported signs and symptoms whose course is marked by remissions and exacerbation. A mnemonic for the clinical features of multiple sclerosis is VISUAL:
V: Visual disturbances (blurring, fogginess, haziness, temporary blindness, double vision, eyeball pain).
I: Internuclear ophthalmoplegia (ie, of the brain stem pathway that coordinates eye movement), which causes paresis of the medial rectus muscle on lateral conjugate gaze, but not on convergence; nystagmus is seen in the abducting eye.
S: Sensory sensations (tingling, pins and needles, numbness, dead-feeling limbs, band-like tightness).
U: Unusual clumsiness, extremity weakness, leg dragging, muscle stiffness, limb heaviness.
A: All symptoms provoked and/or intensified by hyperthermia.
L: Lhermitte's sign. Flexion of the neck produces an electrical sensation that runs down the back and into the legs. This sign suggests intramedullary disease of the cervical cord.
Priscilla Ann Taylor, MN, CGRN
Gig Harbor, Wash