100% tevredenheidsgarantie Direct beschikbaar na je betaling Lees online óf als PDF Geen vaste maandelijkse kosten
logo-home
Eerder door jou gezocht
Eerder door jou gezocht
logo
Lecture Notes - Clinical Immunology - Multiple Sclerosis €3,99
In winkelwagen
Snel navigeren naar
Voorbeeld
  2.  
  3. Vrije Universiteit Amsterdam (VU)
  4.  
  5. Clinical Immunology

College aantekeningen

Lecture Notes - Clinical Immunology - Multiple Sclerosis
 0 keer verkocht

Clinical aspects of multiple sclerosis (including treatment approaches), the animal models for MS, pathology of MS, theoretical concepts of MS

Voorbeeld 3 van de 29  pagina's

Document informatie

  • 30 januari 2020
  • 29
  • 2019/2020
  • College aantekeningen
  • Onbekend
  • Alle colleges

Onderwerpen

Geschreven voor

Alle documenten voor dit vak (3)

Verkoper

avatar-seller
oddsters

Voorbeeld van de inhoud

CLINICAL IMMUNOLOGY
Topic 1: Multiple Sclerosis
LECTURE 1: OVERVIEW OF MS CLINICAL ASPECTS Monday, 28/10/2019
Affects 2-3 million individuals globally  1:1000 in the Netherlands diagnosed with MS; affects women more
than men (2-3 : 1), disease of the young (20-40 yo)


CNS disease in the spinal cord; primary
pathology: INFLAMMATORY
DEMYELINATION of axonal myelin 
disrupted axonal function due to
demyelinating lesions, detectable in MRI

Secondary pathological process: NON-
INFLAMMATORY DEGENERATION  not so
visible in MRI; seen as atrophic lesions only if
it’s severe enough



Degeneration in MS: chronic demyelination of axons + gliosis of astrocytes + chronic activation of microglia
MRI localizations to look for MS lesions:
a. Periventricular
b. Juxtacortical – cortical (below or in the cerebral cortex)
c. Infratentorial (cerebellum & brainstem)
d. Spinal cord

Causes of MS:
a. Familial  e.g. in monozygotic twins, 30% chance to develop MS among them, 2-5% increased risk if a
first-degree relative is affected
b. Environmental  further away from equator, lower vit D status affect the risk of MS; viruses (EBV),
smoking (also associated with worse MS outcome), early obesity (e.g. since childhood)
c. Genes  HLA region on chromosome 6 (also associated with many other autoimmune diseases, in
addition to MS); allelic variants in HLA-DRA locus is identified as risk factors for MS development –
more variants = more likely to develop MS

Symptoms of MS:
a. Optic neuritis (70% of all cases complains of having this; if one
has optic neuritis, there’s 50% chance to have MS diagnosis
later, thus require thorough MRI scan)  decreased acuity,
central blurry-ness, loss of colour discrimination, retroorbital
pain
Eye movements disorder  diplopia (d/t brainstem MS
lesion, usually in younger patients)
b. Lhermitte’s sign (if lesion in spinal cord)  flexing the neck
(extend the spinal cord) causes the “electrical transmission”
down the back; MS suspicion if Lhermitte (+) in young patients,
Ddx for Lhermitte (+):
c. Motor symptoms (d/t demyelinating lesions down the motor
tract)  loss of strength
d. Bladder-sexual dysfunction (one of the most common) 
incontinence, sexual dysfunction
e. Psychological function disorders  attention deficit, memory
loss, disturbed language functions, unable to multitask/slower
functioning
f. Fatigue (most common – albeit invisible): high impact, but
cause is unknown

, CLINICAL IMMUNOLOGY
Topic 1: Multiple Sclerosis
Symptoms arise due to inflammation within CNS  semi-acute attack; origin: optic nerve, brain stem, spinal
cord. Mostly comes to the clinic with exacerbation of neurological symptoms  keep on increasing over a few
weeks, then stagnates (complete/incomplete remission) before it comes up again

MS courses:
a. RRMS (relapsing remitting MS – most
common)  inflammatory
predominance; unpredictable accidents
b. SPMS (secondary progressive MS) 
degenerative predominance
c. PPMS (primary progressive MS) 
typically older, male patients




How to diagnose MS:
Dx criteria: McDonald criteria (see below)

Monitored over 1 year

Diagnosis of MS has to be
reassured, both clinically &
radiologically, before
communicating to the patient 
report this as CIS/clinically
isolated syndrome (symptoms +
w/o radiological evidence) or
RIS/radiological isolated
syndrome (radio + w/o
symptoms)

, CLINICAL IMMUNOLOGY
Topic 1: Multiple Sclerosis
Presence of oligoclonal bands in CSF  if
oligoclonal bands concentration is high,
it is indicative for MS tx
Oligoclonal band: proteins that present
when there is inflammatory lesion of
CNS, when coupled with demyelinating
lesion evidence in MRI and/or MS
symptoms = MS

Other cases that allows presence of
oligoclonal band in CSF: … (?)




Has to make sure of both “dissemination in space & time”
a. Dissemination in space  demyelinating lesions visible in 2 out of 4 localizations in MRI
b. Dissemination in time  >1x relapse OR new lesions on follow-up MRI, contrast-enhancing lesion +
non-enhancing lesions at the same time
Contrast-enhancing lesion: active lesion/newly formed
Non-contrast-enhancing lesion: older lesion, but we don’t know how old


Tx aimed at RIS/CIS has to be weighed carefully
 harm vs. benefit, although the risk of MS
development in those with RIS/CIS history is
very high

Diagnosis of PPMS has different Dx criteria:
a. Progression (+)
b. 2/3 the criteria above (time OR space OR
oligoclonal band)

MS follow up:
a. Clinical: frequency depending on
severity
b. Radiological (after 3 months)
c. Biochemical (biomarkers: neuro filament
light  elevated when axon is broken
down, increased in serum & CSF)

Dit zijn jouw voordelen als je samenvattingen koopt bij Stuvia:

Bewezen kwaliteit door reviews

Bewezen kwaliteit door reviews

Studenten hebben al meer dan 850.000 samenvattingen beoordeeld. Zo weet jij zeker dat je de beste keuze maakt!

In een paar klikken geregeld

In een paar klikken geregeld

Geen gedoe — betaal gewoon eenmalig met iDeal, creditcard of je Stuvia-tegoed en je bent klaar. Geen abonnement nodig.

Direct to-the-point

Direct to-the-point

Studenten maken samenvattingen voor studenten. Dat betekent: actuele inhoud waar jij écht wat aan hebt. Geen overbodige details!

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 oddsters. Stuvia faciliteert de betaling aan de verkoper.

Zit ik meteen vast aan een abonnement?

Nee, je koopt alleen deze samenvatting voor €3,99. Je zit daarna nergens aan vast.

Is Stuvia te vertrouwen?

4,6 sterren op Google & Trustpilot (+1000 reviews)

Afgelopen 30 dagen zijn er 68560 samenvattingen verkocht

Opgericht in 2010, al 15 jaar dé plek om samenvattingen te kopen

Begin nu gratis

Laatst bekeken door jou

Tentamen (uitwerkingen) ·

(0)

NR 442 RN COMMUNITY HEALTH PRACTICE EXAM A (50 ITEMS)

Tentamen (uitwerkingen) ·

(0)

Dental Assisting: Final Exam|76 Questions and answers
€3,99
  • (0)
In winkelwagen
Toegevoegd