If you’ve ever been called in to assess a young woman with vague numbness, weird visual complaints, and a scan that “might be something demyelinating” — congratulations, you’ve stepped into the MS Twilight Zone. 😵💫
Multiple Sclerosis (MS) is a master of disguise. It loves masquerading as everything from anxiety to stroke to malingering — often all at once. So how do we keep track of its chaos? Enter a clever mnemonic that spells out the disease itself:
D.E.M.Y.E.L.I.N.A.T.I.O.N.
Yes, it’s long. But then again, so are most of our differentials before the MRI report comes in.
The Mnemonic: DEMYELINATION
| Letter | Symptom | Clinical Pearls |
|---|---|---|
| D | Diplopia | Often internuclear ophthalmoplegia — that classic MLF lesion 🎯 |
| E | Eye movement painful | Think optic neuritis — pain with movement + vision loss 👁️ |
| M | Motor: weakness, spasticity | UMN signs: ↑tone, brisk reflexes, Babinski 👣 |
| Y | nYstagmus | Brainstem/vestibular pathway involvement 🎢 |
| E | Elevated temperature worsens sx | Uhthoff’s phenomenon — classic! A hot shower = sudden symptom flare 🔥🚿 |
| L | Lhermitte’s phenomenon | Electric-shock sensation on neck flexion ⚡ |
| N | Neuropathic pain | Burning, stabbing — sometimes the only initial clue 🩻 |
| A | Ataxia | Cerebellar dysfunction or sensory ataxia 🌀 |
| T | Talking slurred | Dysarthria — brainstem or cerebellar lesion 🗣️ |
| I | Impotence | Autonomic involvement — sexual dysfunction in both genders 🧊 |
| O | Overactive bladder | Urge incontinence, frequency — spinal cord plaques 💦 |
| N | Numbness | Usually patchy, transient — often missed or minimized by patients 🤷♂️ |
🏥 From the Quetta Wards: A Patient from Washuk
We had a 27-year-old female from Washuk who came in with “fatigue and vision blurriness.” Initially thought to be migraine. But when Dr. Basit Khan noticed her painful eye movement, and I spotted subtle nystagmus, we pushed for MRI.
Turns out — multiple demyelinating lesions. She even had a history of brief leg weakness 6 months earlier, ignored as “sitting too long during weddings.” Classic MS prodrome hidden in plain sight.
Treatment? Methylpred, followed by disease-modifying therapy coordinated with neurology. Prognosis? Much better when caught early.
🧠 Diagnostic Tips from the Trench
- MRI Brain + Spine with contrast = Gold standard for diagnosis
- CSF Oligoclonal bands = Supportive evidence 🧪
- Always ask about heat sensitivity and sexual/urinary symptoms — patients usually don’t bring these up unless you do
- Look for dissemination in time + space — McDonald criteria, not the burger 🍔
My final words regarding MS…
Multiple Sclerosis is not a diagnosis of exclusion — it’s a diagnosis of pattern recognition. If you train your brain to spot the red flags with this “DEMYELINATION” mnemonic, you’ll avoid months (or years) of misdiagnoses and unnecessary psych referrals (sorry Dr. Behroz Rahim 😅).
🧠 Because when a young patient’s symptoms don’t make sense — MS always should.
Happy learning, folks! I hope that you find this article useful in your studies/clinical practice.
Authored:
Dr. Aurangzaib Qambrani
📍 Sheikh Khalifa Bin Zayed Hospital, Quetta
🩺 Departments: General Medicine, Gastroenterology, Cardiac Care Unit
📚 MBBS | PLAB | MRCP (UK)
