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Autoimmune - Neuro

Dr. Ziegler Neurological Disease - Autoimmune

TermDefinition
de-myelinating diseases optic neuritis, multiple sclerosis, neuromyelitis optica, progressive multifocal leukoencephalopathy
optic neuritis inflammatory de-myelination of the ON; ~50% of patients develop MS; vision loss, typically monocular, eye pain during eye movements
etiology of optic neuritis - inflammatory process triggers during or after viral resolution - pro-inflammatory chemical exposure - vitamin B12 deficiency
visual loss due to optic neuritis central scotoma, reduced acuity around scotoma, impaired color detection - can be complete vision loss (typically monocular)
diagnostic testing for optic neuritis - optic disc can be swollen, inflamed, pallor - afferent pupillary defect - primary visual cortex responding to alternating checkerboard stimulus - long latency of cortical response with normal amplitude (consistent with de-myelination)
temporal profile of optic neuritis - onset: hours to days (max 1 wk) - duration: <2 weeks - recovery: 6 weeks to months
reasons to suspect a DD than optic neuritis age of 45+, absence of eye pain, bilateral, visual loss lasting more than 2 weeks, no recovery stage
multiple sclerosis "MS" range of findings: - cognitive defects, psychiatric symptoms - cranial nerve deficits (such as oculomotor) - cerebellum: poor coordination, tremor - motor exam: weakness, abnormal reflexes - sensory exam: Lhermitte's sign, sensory loss
diagnostic criteria for MS MRI: 2+ white matter lesions "plaques" (can be supratentorial, infratentorial, spinal cord); finger extensions from periventricular zone Reduced conduction velocity (increased latency) on evoked potentional CSF: oligoclonal bands
oligoclonal bands in CSF in MS: abnormal presence of bands at specific molecular weights; reflects large amount of IgG being produced; elevated lymphocyte count in CSF
bilateral MLF lesion due to MS bilateral; pure CN3 functions remain intact but MR won't follow LR during lateral conjugate gaze
temporal profile of multiple sclerosis 50% have a prior episode of optic neuritis; relapse-remitting or cyclic can become chronic and progressive
neuromyelitis optica "NMO" - MS mimic disorder - de-myelination of optic nerves and spinal cord - bilateral vision loss, level down sensory & motor deficits - multifocal but acute & stable - autoimmune: aquaporin 4 antibodies
acute disseminated encephalomyelitis "ADEM" inflammatory damage to white and gray matter, mimics MS or stroke (more often gray matter damage); typically after infection or vaccination
ADEM profile - multi-focal/diffuse - acute onset - non-localizing signs (initial presentation may be focal mimicking stroke) except localization does not conform to a single vascular territory or lesion site
progressive multifocal leukoencephalopathy - viral infection of oligodendrocytes (papovavirus of JC virus); multi foci of white matter de-myelination and damage in the CNS
progressive multifocal leukoencephalopathy profile - subacute and progressive - can be fatal - can progress to dementia - typically no pain
leukodystrophy - dys-myelinating disorders involve myelin structure and function defects - myelination of CNS begins in utero/early childhood - myelination is impaired or defective - symptoms present during 1st 2 years of life (can be delayed though)
autoimmune encephalitis antibody-mediated diffuse inflammatory diseases of brain *subacute onset, CSF show pleocytosis (elevated WBC)
NMDA-R autoimmune encephalitis antibodies against NMDA type glutamate; diffuse inflammation that mimicked psychotic psychiatric conditions; initially misdiagnosed, nearly fatal
triggering events for auto-antibodies paraneoplastic syndrome, immune check point inhibitor Rx, post-infection (most common HSV)
autoimmune encephalitis generic aspects - inflammation: increased intracranial pressure and meningeal irritation signs - paraneoplastic cases - seizures - diagnosis of exclusion: signs of increased intracranial pressure doesn't fit with psychiatric disorder
anti-NMDA glutamate receptor most common type of autoimmune encephalitis, diffuse due to ubiquitous distribution of NMDA receptors, mimics psychotic disorders, major cases have ovarian/testicular teratoma
anti-GABA or anti-GAD enzyme that synthesize GABA: psychiatric, seizures
anti-myelin oligodendrocyte glycoprotien diffuse white matter, motor
anti-yo purkinje neurons of cerebellum affects all cerebellar systems
myasthenia gravis "MG" antibody autoimmune attack on nAchR; induces receptor internalization and impairs NMJ function; presents as fatigueable
tensilon test use of edrophonium (AchEI) to test for MG
MG presentation - diffuse weakness, weakness of EOMs, weakness of levator palpebral (ptosis) - progressive, relapse-remitting pattern
Lambert-eaton syndrome antibody-mediated autoimmune attack against calcium channels coupled to Act release in skeletal muscle and ANS; limb muscles affected but EOMs spared (presynaptically) >> AChEI not effective
demyelinating autoimmune attack against myelin sheath or Schwann cell; detected as slowing of nerve conduction velocity
axonopathy neurodegenerative - detected as reduction in amplitude of nerve conduction due to loss of some axons, many still intact
neuronopathy sensory: degeneration of neuronal cell bodies of sensory in DRG motor: motoneurons of spinal cord
guillaine-barre syndrome (acute inflammatory demyelinating polyneuropathy) emerges after an infection resolves, weakness & sensory loss legs, arms, face, motor weakness, symmetrical and diffuse
oculomotor myopathies weakness most often with eye and lid elevation, often diplopia occurs major etiologies: hyperthyroidism, mitochondrial DNA mutation
duchenne muscular dystrophy "DMD" mutation in dystrophin, pediatric disorder with progressive diffuse weakness (wheel chair bound), common early signs: toe-walking, waddling gait, gower's sign
Created by: kycokate
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