Immune- mediated diseases of the Nervous System. Session structure Monday 19 th – lecture Monday pm – SDL – Case: Multiple sclerosis Tuesday 20 th – Case answers. Immune- mediated diseases of the Nervous System. Aim :
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Monday 19th – lecture
Monday pm – SDL – Case: Multiple sclerosis
Tuesday 20th – Case answers
To introduce diseases of the nervous system where autoimmunity contributes to disease pathogenesis
T lymphocytes:T helper cells (CD4)
Tcytotoxic cells (CD8)
Help macrophages to get rid of intracellular microbes
Kill virus infected cells
With T helper cells
Plasma cells in tissues
Normally the brain is shielded from the immune system – limit inflammation attributed to:
Primary abnormality is a decrease in functional acetyl choline receptors at the post-synaptic muscle membrane
This leads to reduction of muscle endplate potential which is often insufficient to trigger a muscle action potential
Pathogenesis mediated by autoantibodies to ACR
35 yr old female presented with loss of vision in her left eye. She had had attacks of insomnia and had lost weight during the last year and felt tired and depressed.
She had remembered an episode of tingling sensation in her left leg 3 years previously, lasted for some weeks and then disappeared.
On examination vital signs were normal. Neurological examination revealed partial loss of vision in her left eye, and ophthalmoscopy revealed inflamed optic nerve. Both legs were hyper-reflexic with increased muscle tone.
Examinastion of CSF by lumbar puncture showed 7 cells/ml, normal protein conc. (0.43 g/l) but increased IgG conc. (0.12g/l). An MRI scan revealed multiple foci of demyelination in both cerebral lobes as well as the left optic nerve.
In this case the presence of a long history, relapsing remitting symptoms, evidence for involvement of multiple parts of the nervous system, plus the CSF and imaging findings strongly suggest a diagnosis of MS