Multiple Sclerosis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Gait [ataxia (gait disorders)]
      • Tremor [tremor]
      • Extremities
    • Auscultation (listening) of the heart
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen), etc.
  • Ophthalmological examination [due tosymptoms:
    • Optic neuritis (inflammation of the optic nerve; usually unilateral; symptoms: Visual disturbances are sometimes preceded by pain in the eye region (= eye movement pain; 92% of patients), lasting a few days to weeks and occurring emphatically with eye movements; increase in often unilateral visual deterioration over days, with flashes of light often provoked by eye movements; improvement of visual disturbances in 95% of cases).
    • Periorbital pain]

    Investigative measures:

    • Ophthalmoscopy (ophthalmoscopy) – The fundus of the eye appears unremarkable on ophthalmoscopy (“the (eye) doctor sees nothing and the patient sees nothing”);if necessary, slight papilledema (optic nerve papilla shows blurred borders and a slight protrusion (one-third of patients).
    • Visual acuity determination (visual acuity determination) [in optic neuritis from “no light appearance” to 1.5; in two-thirds of MS patients < 0.5; normal findings: 20-year-olds: 1.0-1.6, 80-year-olds: 0.6-1.0]
    • Swinging-flashlight test (SWIFT; pupil alternating exposure test; pupil comparison test) – routine examination with which the pupil afference can be assessed relatively quickly (afference = nerve fibers running from the periphery to the central nervous system).Procedure: in a darkened room, the examiner uses a rod lamp to illuminate both pupils in succession from obliquely below for about 3 seconds. This procedure is repeated about four to five times. Observation is made to see if contraction occurs in the illuminated pupil and the speed and extent of contraction is compared with the response of the contralateral pupil. SWIFT test result: The contraction behavior of both pupils is identical in healthy subjects. In the MS patient, the pupil in the painful eye is shown to respond more slowly; there is a relative afferent pupillary defect (RAPD), suggesting a lesion of the optic nerve.
    • Evidence of the “Pulfrich phenomenon”: back-and-forth oscillation of an object parallel to the plane of the face is perceived as circular motion.
  • Neurological examination – including testing of reflexes, testing of sensitivity: tuning fork test with a 128-hertz tuning fork to test vibration perception; localization: big toe; prodomal symptom (symptom indicating a disease)/evidence of disturbance of a vibration perception in patients with spatially disseminated T2 lesions) and motor function etc. [hyperreflexia – increased reflexes; paresthesias – altered sensitivity such as tingling or prickling/with sensory disturbances; spasticity – increase in muscle tension].
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.