Which disease presents with signs such as decreased vision, diplopia, nystagmus, paresthesia, fatigue, tremors, and gait instability?

• A. Amyotrophic Lateral Sclerosis
• B. Parkinson's Disease
• C. Multiple Sclerosis
• D. Alzheimer's Disease

Answer: (C)

A demyelinating process in the central nervous system best explains this mix of signs. Decreased vision and diplopia with nystagmus point to involvement of the optic nerves and brainstem/oculomotor pathways, while paresthesias reflect sensory tract involvement. Fatigue and gait instability, along with tremor, suggest cerebellar or dorsal column/spinocerebellar tract involvement. This combination across vision, eye movements, sensation, and balance is characteristic of multiple sclerosis, which classically presents with episodes of neurologic dysfunction that occur in different parts of the CNS and can come and go over time (relapsing-remitting course).

Other diseases don’t fit this pattern as well: amyotrophic lateral sclerosis primarily causes progressively worsening motor weakness with little primary visual or cerebellar involvement; Parkinson’s disease features resting tremor with rigidity and bradykinesia rather than optic neuritis or widespread sensory symptoms; Alzheimer's disease is a progressive cortical dementia with prominent memory and cognitive deficits rather than acute optic/oculomotor signs and ataxia.