Again, however, it is impossible to determine with a single attack whether or not the patient has simply experienced the first of many MS attacks. Neurological signs and symptoms are variable and nonspecific, but evidence of upper motor neuron dysfunction is the rule. Headache, meningimus, and altered mental status with confusion progressing to lethargy and coma are common accompaniments. Cranial nerve involvement is common, particularly optic neuritis. Motor involvement ranges from focal spastic weakness to quadraplegia.
Sensory findings are almost always present.
Often there is evidence of transverse myelitis. Deep tendon reflexes may initially be decreased, but usually are increased with Babinski signs present. Cerebellar dysfunction is common and initially may be the only finding. Laboratory evaluation typically shows a CSF pleocytosis with up to 150-200 WBCs, generally with a lymphocytic predominance. Radiological evaluation is quite helpful.