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While conventional magnetic resonance, X-ray-based, ultrasound, and nuclear medicine techniques are widely used to facilitate diagnosis, inform therapeutic decision-making, provide information regarding prognosis, and monitor therapeutic response in neurologic diseases, their practical value in acute clinical care is not as yet well-defined and the potential future development is not fully appreciated. This book provides a comprehensive survey of best practice for specialists and trainees in neurology, emergency medicine, neuroradiology, radiology, neurosurgery, and critical care. The symptom-based approach guides the choice of the available imaging tools for efficient, accurate, and cost-effective diagnosis to support immediate management of common and complex neurological disorders in the acute setting. Effective examination algorithms are included that integrate neurological and imaging concepts with the practical demands and constraints of emergency care. Written by leading international authorities, the book is extensively illustrated and contains many helpful case-histories.
This chapter focuses on how the immune system is thought to contribute to the multiple sclerosis (MS) process through the different disease phases, including initiation and propagation, and in different anatomical compartments. Several subsets of regulatory T-cells are capable of inhibiting activation of other T-cells, including suppression of autoimmune responses. Clinical trials of B-cell depletion with rituximab and more recently ocrelizumab have demonstrated substantial reductions in new brain lesions, and relapses in MS patients. The innate immune system rapidly senses foreign pathogen-associated structures without the need for adaptive antigen-specific recognition or memory responses. The presence of clonally expanded CD4 and CD8 T-cells persisting in the CNS, suggests that T-cells can be activated or re-activated within the central nervous system (CNS) compartment. Cellular immune responses and soluble factors can have protective and potentially growth permissive influences capable of limiting injury, as well as promoting survival and repair of neural elements.