Abstract
one or both eyes (a frequent early sign caused by optic neuritis); vertigo; tinnitus; diminished hearing; electric shocklike sensation down the spine when the neck is flexed (called Lhermitte's sign); and diminished vibration and position sense. * Motor: weakness or paralysis of limbs, trunk, head; double vision (diplopia due to oculomotor weakness); and spasticity of more chronically involved weak or paralyzed muscles. * Coordination: intention tremor of limbs and eyes (nystagmus); slurring, scanning speech (dysarthria); difficulty swallowing (dysphagia); and staggering gait (ataxia). * Mental: intellectual function remains intact; depression is not uncommon; later, in presence of major disability, inappropriate euphoria may be observed. * Fatigue: characteristic of MS and greatly aggravated by heat. Humid, hot summer weather may greatly accentuate all signs and symptoms, especially fatigue, as may temporary overheating from exercise (transient reappearance of blurred vision, weakness, numbness, and other paresthesias). The fatigue is a physical phenomenon of unknown etiology, and even the heat of a hot bath may be so disabling that patients cannot get out of the tub unaided. The rapid onset of feelings of extreme fatigue-as opposed to feelings of relaxation-caused by a hot bath is considered a diagnostic test. Two other major functional disorders bear special mention because of their additional psychosocial significance:
Published Version
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