Paroxysmal symptoms - such as trigeminal neuralgia with brief agonising facial pain, tonic seizures, dysarthria and ataxia. 7. Lhermitte's sign - not

pain rare Impairment of postural or vibration sense. 4. Ocular - Unilateral retrobulbar neuritis, pallor of temporal half of disc in 50%. Diplopia and nystagmus common 5. Mental - Emotional changes, euphoria, delusions, terminal dementia. 6. Paroxysmal symptoms - such as trigeminal neuralgia with brief agonising facial pain, tonic seizures, dysarthria and ataxia. 7. Lhermitte's sign - not specific but highly suggestive. 8. Uhthoffs phenomenon - Worsening of weakness or vision with heat, e.g. hot bath, or exercise CRITERIA FOR DIAGNOSIS -1. Age of onset 10-50 years. 2. Lesions dissociated in time and place. 3. Predominantly white-matter affection. 4. Interval between episodes about one month or chronic progressive over 6 months (especially in older people). 5. Disease lasting for more than a year. 6. All other causes have been ruled out. Investigations: 1. CSF -Increase in total protein upto 1 g/litre, or increase in lymphocytes upto 50 x 106 /litre or both. Oligoclonal IgG (in 90%), but not specific. 2. Evoked potentials - Visual evoked potential often delayed. 3. MRI - Most useful investigation. Areas of demyelinating plaques visible on MRI imaging with gadolinium contrast Cd-DPTA-enhanced MRI. May also be seen in inflammatory, granulomatous and vascular disorders. Diff. Diag. of multifocal CNS syndrome with relapsing and remitting course in young adults (a) Inflammatory disorders -Isolated angiitis of CNS, SLE, primary Sjogren's syndrome, Bechet's disease, polyarteritis nodosa.