Which of the following is an example of a recurrent T-cell predominant CNS inflammatory disease?
Group of answer choices
- Neuromyelitis optica (Devic disease)
- Multiple sclerosis
- Acute demyelinating encephalomyelitis (ADEM)
- Neurosarcoidosis
The correct answer is: Multiple sclerosis
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Explanation:
Multiple sclerosis (MS) is the prototypical recurrent, T-cell-mediated CNS inflammatory demyelinating disease, characterized by:
- CD4+ and CD8+ T-cell infiltration targeting myelin in the brain/spinal cord.
- Episodic relapses (in relapsing-remitting MS) with plaques visible on MRI.
- Th1/Th17-driven autoimmunity against myelin proteins (e.g., MBP, PLP).
Why Not the Others?
- Neuromyelitis optica (NMO/Devic disease):
- Antibody-mediated (anti-AQP4 IgG) pathology (B-cell/plasma cell predominant).
- Targets astrocytes, not just myelin.
- Acute disseminated encephalomyelitis (ADEM):
- Monophasic (typically post-infectious), not recurrent.
- Neurosarcoidosis:
- Non-caseating granulomas (macrophage/T-cell mix), not purely T-cell-driven demyelination.
Key Insight:
While all are CNS inflammatory disorders, MS is uniquely recurrent and T-cell predominant.
Thus, multiple sclerosis is the correct answer.
