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Multiple Sclerosis l: Introduction01:19

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Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
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Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
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Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...
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DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic...
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Arboviral encephalitis refers to brain inflammation caused by arthropod-borne viruses, particularly those transmitted through mosquito vectors. Among these, West Nile virus (WNV), a member of the Flaviviridae family, is a significant public health concern. WNV is an enveloped, positive-sense, single-stranded RNA virus. Human infection typically begins when an infected mosquito introduces the virus into the dermis during feeding. The primary transmission cycle involves birds as amplifying hosts...
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Area of Science:

  • Neuroimmunology
  • Neurology
  • Infectious Neurology

Background:

  • Natalizumab is an effective disease-modifying therapy for relapsing-remitting multiple sclerosis (RRMS).
  • Long-term natalizumab use is associated with an increased risk of progressive multifocal leukoencephalopathy (PML), a rare but serious opportunistic infection of the brain.
  • Monitoring for PML symptoms is crucial in patients on natalizumab therapy.

Observation:

  • A 55-year-old woman with RRMS on natalizumab for 3 years presented with acute neurological decline, including word-finding difficulties, gait instability, hemianopia, hemiplegia, sensory loss, and aphasia.
  • Neuroimaging (MRI, PET) and electroencephalogram confirmed the diagnosis of natalizumab-induced PML.
  • The patient experienced rapid neurological deterioration suggestive of demyelination and potential JC virus reactivation.

Findings:

  • The patient was treated with plasmapheresis to remove natalizumab, intravenous immunoglobulin, and high-dose intravenous steroids.
  • A 3-month hospital course involved intensive management and gradual tapering of steroid therapy.
  • Neurological deficits, including speech, motor function, and ambulation, showed marked improvement following treatment.

Implications:

  • This case highlights the importance of vigilant monitoring for PML in natalizumab-treated MS patients.
  • Prompt diagnosis and aggressive management, including natalizumab withdrawal and immunomodulatory therapies, can lead to favorable outcomes.
  • Understanding the risk-benefit profile of natalizumab is essential for optimizing patient care in multiple sclerosis management.