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Related Concept Videos

Brainstem01:19

Brainstem

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The brainstem, located inferior to the brain and superior to the spinal cord, serves as a bridge between the cerebrum and the spinal cord. It plays a vital role in relaying information and controlling critical life functions. It comprises three primary regions: the midbrain, pons, and medulla oblongata.
The Midbrain
The midbrain is located beneath the diencephalon and connects the cerebrum with the lower parts of the brain. The cerebral peduncles are prominent midbrain structures that house the...
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Initiation of Translation02:33

Initiation of Translation

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Initiating translation is complex because it involves multiple molecules. Initiator tRNA, ribosomal subunits, and eukaryotic initiation factors (eIFs) are all required to assemble on the initiation codon of mRNA. This process consists of several steps that are mediated by different eIFs.
First, the initiator tRNA must be selected from the pool of elongator tRNAs by eukaryotic initiation factor 2 (eIF2). The initiator tRNA (Met-tRNAi) has conserved sequence elements including modified bases at...
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Initiation of Translation02:33

Initiation of Translation

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Long-term Depression01:05

Long-term Depression

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Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.
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Brainstem: Control Centers of Medulla01:21

Brainstem: Control Centers of Medulla

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The medulla oblongata is a crucial part of the brainstem responsible for controlling various autonomic and involuntary functions. It contains several nuclei, including the olivary, cuneate, gracile, and solitary nuclei.
Olivary Nucleus
The olivary nucleus, or inferior olivary nucleus, is located within the ventrolateral part of the medulla oblongata. It is primarily involved in motor coordination and motor learning. The olivary nucleus receives input from the spinal cord, cerebellum, and motor...
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Transcription Initiation01:47

Transcription Initiation

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Initiation is the first step of transcription in eukaryotes. Prokaryotic RNA Polymerase (RNAP) can bind to the template DNA and start transcribing. On the other hand, transcription in eukaryotes requires additional proteins, called transcription factors, to first bind to the promoter region in the DNA template. This binding helps recruit the specific RNAP that can assemble on the DNA and start transcription.
The promoters and enhancers and their accessory proteins allow tight regulation of...
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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
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Tumefactive multiple sclerosis which initially presented with brainstem encephalitis with a long-term follow-up.

Akihiko Mitsutake1, Tatsuya Sato2, Junko Katsumata2

  • 1Department of Neurology, Tokyo Teishin Hospital, 2-14-23 Fujimi, Chiyoda-ku, Tokyo 102-8798, Japan; Department of Neurology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

Multiple Sclerosis and Related Disorders
|April 22, 2019
PubMed
Summary

This case study details a rare instance of tumefactive multiple sclerosis (MS) presenting as brainstem encephalitis. Long-term steroid use complicated treatment, leading to incomplete recovery and highlighting atypical MS progression.

Keywords:
BrainstemMagnetic resonance imagingRelapsing-remitting multiple sclerosisSteroid treatmentTumefactive demyelinating lesion

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Area of Science:

  • Neurology
  • Neuroimmunology
  • Demyelinating Diseases

Background:

  • Tumefactive demyelinating lesions (TDLs) are uncommon manifestations of multiple sclerosis (MS).
  • This report focuses on a unique case of tumefactive MS with an initial presentation of brainstem encephalitis.

Observation:

  • The patient experienced relapses predominantly in the brainstem for two decades, followed by periventricular white matter involvement.
  • Initial response to steroid treatment was favorable, with recovery.
  • Long-term oral steroid use led to immunodeficiency, precluding aggressive therapies and resulting in incomplete recovery during relapses.

Findings:

  • The clinical course and treatment response deviated from classical multiple sclerosis presentations.
  • This case provides rare insights into the long-term outcomes of tumefactive MS.

Implications:

  • Understanding atypical presentations of tumefactive MS is crucial for accurate diagnosis and management.
  • The long-term effects of immunosuppression in MS require careful consideration.
  • This case underscores the heterogeneity of MS and the importance of individualized treatment strategies.