Summary of lectures Clinical immunology (AM_470655)
8 views 1 purchase
Course
Clinical immunology (AM_470655)
Institution
Vrije Universiteit Amsterdam (VU)
Summary of lectures Clinical immunology (AM_470655) of the master Biomedical Sciences. The summary consist of notets from lectures and also helpful images from the powerpoints for supporting information
Definition: multiple scars in the central nervous system
Multifocal inflammation in the brain and spinal cord.
- White matter
- Gray matter
MS facts
- Prevalence 1:1000 in the NL
- Starts between 20-40 years
- More women are affected than man
- Almost normal life expectancy
- Prevalence increases with higher latitude → less sun → less Vit D
Contributing factors
- Vitamin D levels
- Diet
- Smoking
- Epstein-barr virus/mononucleosis infectiosa
- Ethnicity and genes
Anatomy
- Gray matter → cell bodies of the axons are located here
- White matter → axons surrounded by myelin
- Myelin → improves the conduction → action potential is disrupted because of the
lesions in the brains
- The myelin is build up by oligodendrocytes and are covered by myelin sheets
Pathological hallmarks: chronic inflammatory demyelinating disease of the CNS
→ inflammation, demyelination, remyelination, gliosis (scarring)
Inflammation and demyelination of the CNS
- The blood brain barrier (BBB) is infiltrated by immune cells, the immune cells cause a
immune response in the brain → the immune cells attack the myelin resulting in
lesions in the brain
- The immune cells in in the blood vessels in the white matter → later scaring is
Induced by the immune cells
Remyelination and scarring
- Remyelination: the myelin recovers fully or partially
- Gliosis is the scarring of the brain → the scar formation is formed after the damage of
the demyelination
- The cycle repeats itself
, 2. Clinical symptoms
Clinical features
- Symptoms in MS vary widely, it has different locations and severity
- New neurological symptoms, relapses → slowly progressive symptoms
Symptoms in MS
- Symptoms vary widely → different location and different severity
3. Diagnosis MS
Diagnosis
- Clinical features are checked if it is linked to MS
- Radiological characteristics
- Abnormalities in cerebrospinal fluid
- Diagnosis based on
o Dissemination of time (DIT) → new attacks or relapses
o Dissemination of space (DIS) → different places in your brain or spinal cord
that have been damaged
Symptoms
- Visual problems
o Pain behind the eye, decreased colour vision decreased, diplopia (double
vision)
- Pyramidal symptoms
o Paresis
o Spasticity
o Abnormal reflexes
- Sensory symptoms
o Tingling, Numbness
o Symptom of Lhermite
, - Bladder-/bowel/sexual problems
o Incontinence: urine and faeces
o Urine retention, frequent urinary tract infections, sexual problems
- Coordination problems
o Ataxia
o Tremor
o Balance
- Coordination problems
o Memory, concentration, attentions, difficulties organizing
- Fatique
o High prevalence and there is no good treatment for this
o Unknown cause of the fatique and its less visible
- Less visible
o Depression, suicide, relationship, walking gets difficult after a while
Clinical DIS/DIT
- The first phase the optic neuritis starts. In the second relapse gait problems strt, so a
wheelchair is needed. In the thirs relapse diplopia starts
MRI in MS
- With the MRI the lesions in the brain and in the spinal cor scan be visualized. The
number size and distribution vary widely
- Typical brain lesions are ovoid shaped and are close to the bloodvessels, because this
is the location where the immune cells infiltrate the brain → perivascular orientation
Different types of MRIs for different lesions
- T2 lesions → disease burden
- T1 lesions → black holes, irreversible damage
- T1 contrast → enhancing lesions, active lesions
Specific MS localization
- Specific locations for the lesions
o periventricular: close to the ventricles in the brain
o Juxtacortical: close to the cortex
o Infratentorial: above the cerebellum
o Spinal cord
- Dissemination in SPACE → lesions in 2 of 4 locations
- MRI show dissemination in time → make different MRIs
at different time points
o Combination of different type of lesions
o Combination of T2 lesions and contrast enhancing
lesions
o New T2 lesions over time
MRI in MS - degeneration
- Atrophy: widening of ventricles that happens in a later disease stage in both brain
and spinal cord
- Partially independent from white matter lesion load
- Exclusions of differential diagnosis
- Monitor the disease activity → to determine the efficacy of the treatment and
pharmacovigilance → medicine
, Cerebrospinal fluid (CSF)
- Used to determine the dissemination in time for MS patients
- Oligoclonal bands → extra clue for correct diagnosis of MS
o In MS patients there are a lot of thick IgG oligoclonal bands
o Done by a lumbar puncture
McDonald criteria
- For Dissemination in time and space for diagnosing the patient
Clinically isolated syndrome (CIS)
- Pre-symptoms of MS
- Monosymptomatic clinical presentation demyelination
- Could evolve to MS later
→ do a follow up to determine whether it evolves to MS
4. Disease course and subtypes
Different MS subtypes
- Relapsing-remitting (RRMS)
- Secondary progressive (SPMS)
- Primary progressive (PPS) → progressive
relapsing (PRMS)
Disease progression of MS
- Radiological isolated syndrome (RIS) > CIS
and MS
- Clinically isolated syndrome (CIS) → RRMs
and SPMS
Most common presenting symptoms
- Relapsing-remitting MS: optic
neuritis, sensory symptoms
- Primary progressive MS: motor
symptoms, progressive walking
disabilities
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller tessamuileboom. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.50. You're not tied to anything after your purchase.
