Neuroimmunology

Info

🌱 來自: Huppert’s Notes

Neuroimmunology🚧 施工中

Neuroimmunology

Multiple sclerosis (MS)

•   Diagnostic criteria:

-   Relapsing-remitting MS: An attack, relapse, or exacerbation of symptoms typical of acute inflammatory demyelinating event with duration of at least 24 hours in the absence of fever or infection and clinical and/or radiographic evidence of dissemination in space and time

-   Primary-progressive MS: Progressive accumulation of disability from onset without clear relapses

-   Secondary-progressive MS: Progressive accumulation of disability after an initial relapsing course

•   Symptoms: Optic neuritis (painful vision loss or blurring, color desaturation), internuclear ophthalmoplegia, transverse myelitis

•   Diagnosis: MRI brain (+/– MRI cervical/thoracic spine depending on symptoms) w/wo contrast, LP with basic studies, IgG index, and oligoclonal bands. Rule out other etiologies with labs including HIV antibody, RPR, TSH, B12 with MMA + homocysteine, ESR, CRP, ANA, Sjogren’s antibodies, ACE

•   Treatment:

-   Acute: Optic neuritis- PO and IV steroids are equally efficacious. Severe symptoms such as bilateral optic neuritis or transverse myelitis with paraparesis/quadriparesis may require IV steroids or plasma exchange

-   Chronic: Numerous disease modifying therapies, prescribed by a neurologist

-   If known MS: Rule out pseudoflare (infection, metabolic disturbance, etc.), which worsens previous MS symptoms in the absence of a new or enhancing lesion on imaging

Neuromyelitis optica (NMO)

•   Symptoms: Optic neuritis (often bilateral), acute myelitis, area postrema syndrome (hiccups, nausea, vomiting), acute brainstem syndrome, narcolepsy, symptomatic cerebral syndrome

•   Diagnosis: Serum aquaporin 4 IgG

Acute disseminated encephalomyelitis (ADEM)

•   Description: Acute demyelination within the white matter of the brain and spinal cord following a viral infection or vaccination

•   Symptoms: Often affects children/young adults; causes encephalopathy, weakness

•   Treatment: Steroids, plasmapheresis

Progressive multifocal leukoencephalopathy (PML)

•   Description: Progressive damage of the white matter of the brain caused by the JC virus in immunosuppressed patients

•   Symptoms: Weakness, visual changes, speech changes, personality changes

•   Treatment: No cure. Treatment aimed at reversing the immune deficiency to slow or halt disease progression

•   Prognosis: Poor prognosis, 30–50% fatality