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학습 자료 둘러보기 →| Option | Clinical Interpretation |
|---|---|
| 2. Mild tremor in the dominant hand during fine motor tasks | A mild tremor, especially with intentional movement, is a common cerebellar sign in MS. While it reflects a lesion in the cerebellothalamocortical pathway, its presence as a single, mild finding in a recently diagnosed patient is more consistent with an initial clinical episode or a stable residual deficit rather than a clear signal of progressive disease. Gait impairment, a more functionally impactful motor sign, is a stronger marker of progression . |
| 3. Occasional muscle stiffness in the lower extremities in the morning | Spasticity is a common symptom of upper motor neuron lesions in MS. Occasional morning stiffness is a mild, paroxysmal symptom that can be influenced by immobility during sleep. Its intermittent and predictable nature is less concerning for relentless disease progression than a symptom complex that is increasing in both frequency and severity, which indicates a declining threshold for neuronal function. |
| 4. Intermittent blurred vision that resolves with rest | Blurred vision that resolves with rest is highly characteristic of optic neuritis, a classic presenting symptom of relapsing-remitting MS. Its resolution with rest suggests a self-limiting, relapse-related phenomenon or a Uhthoff's-like symptom triggered by fatigue, rather than a permanent, progressive loss of function. The key differentiator from option 1 is the trajectory: a symptom that is becoming more frequent and severe marks a departure from a stable or purely relapsing course toward a progressive one. |
In MS, disease progression is marked by the accumulation of disability independent of relapses. A critical indicator is the worsening of systemic symptoms like fatigue and heat intolerance, which signal a loss of CNS functional reserve.
This is explained by Uhthoff's phenomenon: an elevated body temperature further impairs conduction velocity in demyelinated axons. An increase in the frequency and severity of this phenomenon indicates underlying neuroaxonal damage.
Do not confuse discrete relapses (e.g., optic neuritis, tremor) with insidious progression. Focus assessment on the patient's report of worsening baseline function, especially fatigue and heat sensitivity.
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