The 50 faces of multiple sclerosis: the diverse presentations of a common disease

Multiple sclerosis (MS) dominates neurological practice in many parts of the world. This is no doubt because it is a common disorder which favours the young.The typical form, relapsing remitting MS (RRMS), is often easy to recognise and diagnose. The are however other types and variants such as primary progressive MS (PPMS), that often pose a challenge to neurologists to pin down.

MRI scan. NIH Image Gallery on Flikr.

There is no single clinical symptom or sign that is pathognomonic of MS. Some presentations are red flags for MS, such as optic neuritis (ON) and transverse myelitis (TM). Many other MS symptoms and syndromes are however non-specific. The ways MS presents are diverse, and below is a list of the 50 different faces of MS.

MRI scan. NIH Image Gallery on Flikr.



Trigeminal neuralgia









Transverse myelitis (TM)

Optic neuritis (ON)

Memory impairment

Executive dysfunction



Spastic paraparesis

Lhermitte’s phenomenon 

Impaired libido

Erectile dysfunction


Uhthoff’s phenomenon

Pulfrich phenomenon


Internuclear ophthalmoplegia (INO) 




Sleep disorders

Heat sensitivity

Tonic spasms


Pathological laughter

Pathological crying

Sensory impairment

Paroxysmal attacks

Radicular symptoms

Restless legs

Excessive daytime sleepiness (EDS)

Olfactory dysfunction

Taste dysfunction



Horner’s syndrome

Respiratory impairment

Paroxysmal kinesigenic dyskinesia (PKD)

Takotsubo cardiomyopathy 


Hand muscle atrophy

Tumefactive MS

Balo’s concentric sclerosis

Movement disorders

MRI scan. NIH Image Gallery on Flikr.
Why not explore the whole of MS with comprehensive checklists? Below are some MS related Neurochecklists to start you off:

Multiple sclerosis (MS): risk factors

Multiple sclerosis (MS): typical clinical features

Multiple sclerosis (MS): unusual features

Multiple sclerosis (MS): differential diagnosis

Primary progressive multiple sclerosis (PPMS)

Clinically isolated syndromes (CIS)

Radiologically isolated syndrome (RIS)

Multiple sclerosis (MS): atypical variants

Tumefactive multiple sclerosis (TMS)

Progressive solitary sclerosis

By Monthly_multiple_sclerosis_anim.gif: Waglionederivative work: Garrondo – This file was derived from  Monthly multiple sclerosis anim.gif: , Public Domain, Link


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