The most common clinical manifestation of Multiple Sclerosis is

(C) Optic Neuritis INITIAL SYMPTOMS OF MULTIPLE SCLEROSISSymptomPercent of CasesSymptomPercent of Cases* Sensory loss37* Lhermitte3* Optic neuritis36* Pain3* Weakness35* Dementia2* Paresthesias24* Visual loss2* Diplopia15* Facial palsy1* Ataxia11* Impotence1* Vertigo6* Myokymia1* Paroxysmal attacks4* Epilepsy1* Bladder4* Falling1# Optic neuritis is the commonest presenting feature of multiple sclerosis out of the given choices. It is roughly seen in 36% of cases.> Sensory loss may be the initial symptom in 37% cases.> Optic neuritis generally presents as decreased acuity, dimness or colour desaturation in central field of vision.> Afferent pupillary response may be detected.> Internuclear (not intranuclear) ophthalmoplegia consists of slow adduction of one eye with nystagmus in the abducting eye.> Impaired adduction is due to lesion in medial longitudinal fasciculus.> Bilateral internuclear ophthalmoplegia is highly suggestive of multiple sclerosis. Lhermitte's symptom (sensation of electric shock on flexion of neck) is seen in multiple sclerosis. Seizure and aphasia are uncommon in multiple sclerosis. Afferent pupillary defect is seen in multiple sclerosis. There is abnormality in visual evoked potential. MRI helps in confirming the diagnosis.