Careful examination of normal-appearing white matter in progressive MS reveals elongated paranodes with a disrupted profile, axonal swellings, and amyloid precursor protein accumulations. These correlate with the density of ramified…
Clinical Features of an MS Relapse: Events during the clinically apparent phase of a relapse, as with its prelude, involve a series of steps. STEP SIX Conduction Block. The symptoms…
STEP EIGHT The Ending of the Relapse. MS relapses have a finite duration. They are curtailed by a classic feedback loop in which the end product eliminates the originator. Most…
STEP THREE Perivascular cuff monocytes function as APCs. They capture local antigenic material, process it, and present processed antigen in the context of surface-expressed MHC class II molecules so as…
STEP ONE This is clinically silent and takes place in the subarachnoid space (SAS) and within the cerebral ventricles. Between 105 and 5 × 105 lymphoid cells are present in…
CEREBROSPINAL FLUID (CSF) ANALYSIS A spinal tap is performed less often today than formerly but may be helpful when the diagnosis is in doubt or to satisfy diagnostic criteria. Total…
When a CD4+ TN cell finally contacts a cognate antigen–expressing DC, it is either activated or tolerized. Both outcomes are germane to MS. Both require contact between the CD4+ TN…
Immature DCs in the CNS subarachnoid space ingest myelin elements; after that, they may mature in situ. Mature DCs express the cell surface molecule C-C chemokine receptor 7 (CCR7), whereas…
From time to time, lesions that appear to be typical for MS turn up unexpectedly on MRI scans of persons with no clinical symptoms suggestive of MS, no history of…
