A 22-year-old woman presents with acute vision loss and pain in the left eye, but no other symptoms. On examination she appears well, visual acuity is not possible, and she can only perceive movement and bright light. The direct papillary reflex is absent but the indirect (consensual) response is normal. The optic disc is edematous. Which of the following symptoms is also most likely present in patients with this condition?
High-Yield Explanation
This patient has multiple sclerosis (MS). Weakness or numbness in one or more limbs is the initial manifestation of disease in about half the patients. Other common initial presentations include optic neuritis (25%) and acute myelitis. Hemiplegia, seizures, and cervical myelopathy (in older patients) occur occasionally as the initial manifestation. Sphincter impairment usually occurs later in the disease.