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
- Aisle
- Tremor (shaking)
- Extremities
- Inspection (viewing).
- Ophthalmological examination [due tosymptoms:
- Eye movement pain: visual disturbances are usually preceded by pain in the eye region (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 (ophthalmologist) sees nothing and the patient sees nothing”); mild papilledema may be present (optic nerve papilla shows blurred borders and mild protrusion; one-third of patients).
- 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 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 4 to 5 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), indicating 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.Note: The Pulfrich phenomenon is considered nonspecific because it also occurs in healthy individuals when one eye is covered with a gray filter.
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.
Further notes
- Uhthoff phenomenon: a transient deterioration of visual acuity occurring after physical exertion-induced temperature elevation. The phenomenon is specific but occurs in only about half of patients with multiple sclerosis. Typical triggers are sports, hot showers and bathing.
