Which of the following is NOT associated with Multiple Sclerosis?

• A. Lhermitte's phenomenon
• B. Macular exudative star
• C. Uhtoff's phenomenon
• D. Bilateral INO

Answer: (B)

Understanding which signs come from CNS demyelination versus retinal conditions helps you tell MS-related findings from other eye diseases. Lhermitte’s phenomenon is an electric shock sensation triggered by neck flexion and reflects cervical spinal cord demyelination, something MS commonly does. Uhthoff’s phenomenon is a temporary worsening of symptoms with heat or exertion, due to slowed conduction in demyelinated fibers, another classic MS feature. Bilateral internuclear ophthalmoplegia arises from demyelination of the medial longitudinal fasciculus, leading to impaired adduction of the eyes with nystagmus on attempted gaze, and it’s a well-known MS sign.

Macular star exudates, or a macular exudative star, are lipid-rich exudates arranged in a star pattern around the fovea. This retinal finding is characteristic of certain retinal or optic nerve conditions such as neuroretinitis (for example, cat scratch disease) and some vascular retinopathies, not MS. So this pattern is not associated with multiple sclerosis.