An update on immunopathogenesis, diagnosis, and treatment of multiple sclerosis

BACKGROUND: Multiple sclerosis is an acquired demyelinating disease of the central nervous system. It is the second most common cause of disability in adults in United States after head trauma. DISCUSSION: The etiology of MS is probably multifactorial, related to genetic, environmental, and several other factors. The pathogenesis is not fully understood but is believed to involve T-cell-mediated inflammation directed against myelin and other related proteins with a possible role for B cells. The McDonald criteria have been proposed and revised over the years to guide the diagnosis of MS and are based on clinical presentation and magnetic resonance imaging (MRI) of the brain and spinal cord to establish dissemination in time and space. The treatment of MS includes disease modification with immunomodulator drugs and symptom management to address the specific symptoms such as fatigue, spasticity, and pain. CONCLUSION: An update on etiology, pathogenesis, diagnosis, and immunomodulatory treatment of MS is presented

Leucine-rich glioma-inactivated protein 1 antibody encephalitis: A case report

OBJECTIVE: To describe a case of leucine-rich glioma-inactivated protein 1 (LGI1) antibody-associated encephalitis. METHODS: The clinical and ancillary data and brain MRIs were gathered retrospectively by chart review. Relevant literature on similar cases was also reviewed. RESULTS: The diagnosis of LGI1 antibody-associated autoimmune encephalitis was based on the typical clinical presentation of seizures, psychiatric symptoms, and memory loss as well as negative diagnostic testing for cancer; the diagnosis was confirmed by positive LGI1 antibody. The patient responded favorably to treatment with IV immunoglobulin and continues to do well. CONCLUSION: LGI1 antibody-associated encephalitis has increasingly been recognized as a primary autoimmune disorder with good prognosis and response to treatment

Immunization in Patients With Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease of the central nerv-ous system characterized by inflammatory demyelination and some axonal damage. An overactive or dysfunctional immune response to self-antigen is believed to be the pathogenic mechanism and therefore the treatment of MS often involves immunosuppressive therapy. Be-cause of altered immune function in patients with MS, questions arise about risk of infections in this population and the safety and efficacy of common immunizations. The risk of MS exacerbation with common infections and safety and efficacy of immunization are reviewed along with the available guidelines for use of vaccines in patients with MS

An anatomic variant caudate lobe in a cadaver

The liver can present a number of congenital anomalies. Most common among them are the irregularities in shape and the number of lobules. Less common variations include presence of accessory lobes or accessory fissures. The accessory lobe may be attached to the liver through a mesentery or a bridge of hepatic tissue and they are usually asymptomatic. An accessory liver lobe though a very rare occurrence but when it exists it becomes clinically important because of its rarity. We are reporting one such case of accessory caudate lobe of liver found during routine dissection of embalmed cadaver of a 60 year old male. It was separated from the caudate lobe by a well-defined fissure. The quadrate lobe and fissure for ligamentum teres were totally absent. Ligamentum teres was found embedded in the substance of the liver on its inferior surface. The presence of additional lobes and fissures or the absence of normal lobes and fissures might lead to confusion during surgery or clinical misdiagnosis. Knowledge and awareness of these anomalies is useful to the clinician to rule out diseases, surgeons during segmental resection of liver and radiologist when interpreting liver radiologic findings

High division of sciatic nerve

Background: The Sciatic nerve is the largest and thickest nerve in the human body with a long course in the inferior extremity. It divides into tibial and common peroneal nerves which can occur at any level from the sacral plexus to the inferior part of the popliteal space. Sciatic nerve variations are relatively common. These variations may contribute to clinical conditions ex sciatica, coccygodynia and piriformis syndrome and have important clinical implications in anaesthesiology, neurology, sports medicine and surgery.Methods:10 cadavers were dissected with no previous history of trauma/surgery to study the anatomical variations of sciatic nerve.Results:In all except two cadavers, the nerve divided at the apex of the popliteal fossa. In two cadavers the sciatic nerve divided bilaterally in the upper part of thigh.Conclusion: The high division presented in this study can make popliteal nerve blocks partially ineffective. The high division of sciatic nerve must always be borne in mind as they have important clinical implications

New Technique for Management of Relaxed Vagina- Preliminary Study

Sexual health is vital to overall well-being. Orgasm is a normal psycho-physiological function of human beings and every woman has the right to feel sexual pleasure. Vaginal and clitoral orgasms are essential for heightened sexual pleasure for which tight vagina having the capability of exerting sufficient pressure over glans penis is essential. Relaxed vagina cannot apply enough pressure over penis during sex and so both vaginal and clitoral orgasms are diminished in intensity. Gynaecologists world over do not recognize the loose vagina in isolation and therefore no proper procedure had been described for correction of loose vagina. We for the first time described a new technique for management of loose vagina in 21 patients and achieved good results

Radiologically Isolated Syndrome: An Overview

The easy and wide availability of brain mag-netic resonance imaging (MRI) in the past two decades has led to its increasing use in evaluation of a variety of neurological symp-toms. Given its widespread use, it is com-mon to detect some incidental findings in patients undergoing brain MRI for unrelated medical indications, such as head trauma or headache. The most common of these inci-dental abnormalities are white matter lesions that based on their appearance, location, and distribution are consistent with demye-lination or multiple sclerosis (MS) but are not associated with any clinical symptoms suggestive of MS. The term radiologically isolated syndrome (RIS) has been proposed to describe this entity. Coined only recently, RIS was first used by Okuda et al1 to describe subjects with no ob-vious present or past neurological symptoms suggestive of MS, normal neurological ex-amination, and white matter lesions on brain MRI fulfilling the radiological criteria of MS.2 The proposed criteria for RIS are listed in Table 1. The Barkhof criteria for radio-logical evidence of dissemination are depict-ed in Table 2. Before the advent and wider availability of MRI, postmortem studies showed a low prevalence (0.1%) of clinically silent demye

Clinical and Neuroimaging Manifestations of Erdheim–Chester Disease: A Review

ABSTRACT Erdheim–Chester disease (ECD) is a rare disorder characterized by accumulation of non‐Langerhans cell histiocytes in multiple organs. The clinical manifestations are protean and vary from asymptomatic focal disease to potentially fatal multisystem disorder. The commonest presentation is symmetric osterosclerotic lesions of lower extremity long bones; other organs, including cardiovascular, nervous, and endocrine system may be affected. Central nervous system involvement can occur in up to 50% cases and is associated with poor prognosis. The disease pathogenesis involves organ involvement secondary to histiocytic infiltration and systemic inflammation driven by Th1 cytokine activation. The recent discovery of activating mutations in proto‐oncogene B‐rapidly accelerated fibrosarcoma (BRAF) V600E and other genes involved in mitogen‐activated protein kinase (MAPK) pathways has led to redefinition of ECD as a myeloid neoplastic disorder. The diagnosis requires histochemical and molecular analysis of histiocytes in tissue biopsies in patients with compatible clinical and imaging features. The treatment options include interferon‐alpha, anakinra, and immunosuppressive therapies. Better understanding of disease pathogenesis has led to development of novel targeted and effective therapies including BRAF and MEK inhibitors. The rarity of the disease and variable clinical features and course often results in diagnostic errors and delays. Rare primary neurological presentation can occur mimicking CNS inflammatory, neoplastic, or demyelinating disorders. We report an unusual case of ECD presenting with progressive encephalopathy and ataxia along with multifocal brainstem and cerebellar lesions. A comprehensive review of clinical and neuroimaging features and immunohistochemical and molecular characteristic of ECD are presented along with review of neuroimaging findings in two previously reported cases

Leucine-rich glioma-inactivated protein 1 antibody encephalitis

Objective: To describe a case of leucine-rich glioma-inactivated protein 1 (LGI1) antibody-associated encephalitis. Methods: The clinical and ancillary data and brain MRIs were gathered retrospectively by chart review. Relevant literature on similar cases was also reviewed. Results: The diagnosis of LGI1 antibody-associated autoimmune encephalitis was based on the typical clinical presentation of seizures, psychiatric symptoms, and memory loss as well as negative diagnostic testing for cancer; the diagnosis was confirmed by positive LGI1 antibody. The patient responded favorably to treatment with IV immunoglobulin and continues to do well. Conclusion: LGI1 antibody-associated encephalitis has increasingly been recognized as a primary autoimmune disorder with good prognosis and response to treatment