Samenvatting
Samenvatting CIPT minor week 1
- Instelling
- Vrije Universiteit Amsterdam (VU)
Samenvatting CIPT minor week 1
[Meer zien]Voorbeeld 2 van de 8 pagina's
Voorbeeld 2 van de 8 pagina's
In winkelwagengesponsord bericht van onze partner
Voorbeeld van de inhoud
Week 1: NeuroimmunolgyClinical aspects of MS
Epidemiology:
● More women than men → 2-3:1
● Typical age: 20-40 years. Age at onset is often lower in females.
● A western disease: Further from the equator → less UV light → lower serum Vitamin
D → higher risk of MS. Not yet been proved, but there seems to be an association.
Pathology:
● MS is exclusively in the CNS. A complex interaction between the immune system,
neurons and glia result in inflammation and destruction of the CNS.
● Major pathological process: Demyelination = breakdown myelin + destruction
oligodendrocytes. B and T cell response → inflammatory process which can be
targeted by therapy.
● Demyelinating lesions: located in the periventricular and juxtacortical regions and
spinal cord (brain stem, cerebellum, optic nerve)
● Degeneration: neuronal loss of chronically demyelinated axons, gliosis of astrocytes
and activated microglia.
Cause: MS is familial: increased risk within the family. HLA region in chromosome 6 has
been associated with MS. Over 200 allelic variants in genes have been identified as a risk
factor for MS.
Symptoms:
Most MS patients have symptoms arising from one or more places of inflammation. The
symptoms typically increase in a relapse, and then complete or incompletely stay for some
time.
● Optic neuritis: decreased vision, mainly in the central visual fields. Disturbance of
colour vision. And pain behind the eye. (This manifestation can also be with other
auto-immune diseases. patients presenting this have a 25-72% chance of MS).
● Eye movement: abnormal. most common is double vision and involuntary eye
movement.
● Lhermitte’s symptom: flexion of the neck causes an electrical-like shooting sensation.
● Motor function: weakness of the limbs. Mostly at one side of the brain, and often arm
& leg.
● Bladder function: due to the lower nerves.
● Psychological functions: slowing of processing, attention deficit, disturbance of
memory and language processing.
● Fatigue: most common and high impact. The cause is unknown.
Diagnosis:
Relapsing-remitting MS (RRMS): occurs at the onset. Symptoms come and go. Tissue
damage accumulates and then they move to the secondary progressive phase.
Secondary progressive MS (SPMS): initial relapse remitting and then suddenly begins to
decline without a period of remission.
, Picture:
First RRMS with ups and downs → then
reaching threshold → become SPSM with minimal
ups and downs → then improvements are only
worsening.
The first stage has more inflammation, the second stage is more degeneration
Diagnosing using the McDonald criteria of 2017. Dysfunction of a variable brain or spinal cord
areas on more than one occasion in time.
> Dissemination in space: two of the four places where the lesions can happen. Someone
with optic neuritis only cannot be labelled as an MS patient.
> Dissemination in time: >1 relapse. MRI shows new lesions. Use contrast to see new
versus old lesions. The presence of oligoclonal bands can be seen in the cerebrospinal fluid.
CSF: used in the diagnosis of MS.
● Oligoclonal bands: antibodies. are always present independent of the relapsing
phase. high sensitivity (90%), and lower specificity.
● IgG index: ration CSF and IgG in serum. Not often used because this could indicate
all types of auto-immune diseases.
Treatment:
● The window of opportunity: active white matter demyelination in the relapsing phase.
● First-line therapy: less effective but also has fewer side effects.
● Second-line therapy: more aggressive treatment.
● Early therapy is needed to delay the accumulation of irreversible neurological
damage.
● Effectiveness vs. risks: Natalizumab is very effective, but the chance of opportunistic
viral infection is bigger → possibility of severe disability or death
Histopathology of MS/Practical class of MS pathology
Main aspects revolving around MS:
● Long clinical course → >40 years
● Hallmarks of MS: demyelination, inflammation/immune response and involvement of
both WM and GM.
● Outside-in hypothesis: a primary autoimmune attack causes myelin and axonal
degeneration in the CNS.
● Inside-out hypothesis: a primary cyto-degenerative process causes myelin
degeneration in the CNS and a secondary autoimmune attack against the
fragmented myelin.
● Spotting the basic hallmarks: myelin proteins in the membrane. PLP is often used.
No PLP = lesion. (PLP colours brown).
White matter lesions: classify based on the level of inflammation. Use APC markers like
MHC-II.
● Active: high MHC-II reactivity inside the lesion. A lot of macrophages and active
microglia. This indicates a new lesion.
● Chronic active: high MHC-II reactivity at the rim. Fewer macrophages. Older lesion
than active.
Voordelen van het kopen van samenvattingen bij Stuvia op een rij:
Verzekerd van kwaliteit door reviews
Stuvia-klanten hebben meer dan 700.000 samenvattingen beoordeeld. Zo weet je zeker dat je de beste documenten koopt!
Snel en makkelijk kopen
Je betaalt supersnel en eenmalig met iDeal, creditcard of Stuvia-tegoed voor de samenvatting. Zonder lidmaatschap.
Focus op de essentie
Samenvattingen worden geschreven voor en door anderen. Daarom zijn de samenvattingen altijd betrouwbaar en actueel. Zo kom je snel tot de kern!
Veelgestelde vragen
Wat krijg ik als ik dit document koop?
Je krijgt een PDF, die direct beschikbaar is na je aankoop. Het gekochte document is altijd, overal en oneindig toegankelijk via je profiel.
Tevredenheidsgarantie: hoe werkt dat?
Onze tevredenheidsgarantie zorgt ervoor dat je altijd een studiedocument vindt dat goed bij je past. Je vult een formulier in en onze klantenservice regelt de rest.
Van wie koop ik deze samenvatting?
Stuvia is een marktplaats, je koop dit document dus niet van ons, maar van verkoper nooralkemade. Stuvia faciliteert de betaling aan de verkoper.
Zit ik meteen vast aan een abonnement?
Nee, je koopt alleen deze samenvatting voor €7,99. Je zit daarna nergens aan vast.
Is Stuvia te vertrouwen?
4,6 sterren op Google & Trustpilot (+1000 reviews)
Afgelopen 30 dagen zijn er 53068 samenvattingen verkocht
Opgericht in 2010, al 14 jaar dé plek om samenvattingen te kopen
