Which symptom is not typically associated with multiple sclerosis?

• A. Optic neuritis
• B. Dysarthria
• C. Pill rolling tremor
• D. Heat intolerance

Answer: (C)

Multiple sclerosis causes focal CNS demyelination that leads to features like optic neuritis, dysarthria, and heat intolerance due to conduction problems in demyelinated fibers. Optic neuritis arises from demyelination of the optic nerve and is a common presenting sign. Dysarthria can result from involvement of motor pathways or cerebellar connections. Heat intolerance, or Uhthoff phenomenon, occurs when increased body temperature temporarily worsens neurologic function in already demyelinated nerves. A pill-rolling tremor is characteristic of Parkinson disease, reflecting degeneration of dopaminergic neurons in the substantia nigra and basal ganglia, and is not a typical MS feature. If tremor occurs in MS, it’s usually an intention or cerebellar-type tremor rather than a resting pill-rolling tremor.