Introduction and objective: The skin is the most important external organ, protecting against pathogens, physical and chemical injuries, as well as ultraviolat (UV) radiation. Continuous exposure to UV radiation, allergens, and pollutants, as well as consumption of highly processed foods, all...

Cytokines regulate immune responses and are crucial to MS pathogenesis. This study evaluated pro-inflammatory and anti-inflammatory cytokine concentrations in the CSF of de novo diagnosed RRMS patients compared to healthy controls. We assessed cytokine levels in the CSF of 118 de novo diagnosed RRMS patients and 112 controls, analyzing relationships with time from symptom onset to diagnosis, MRI lesions, and serum vitamin D levels. Elevated levels of IL-2, IL-4, IL-6, IL-13, FGF-basic, and GM-CSF, and lower levels of IL-1β, IL-1RA, IL-5, IL-7, IL-9, IL-10, IL-12p70, IL-15, G-CSF, PDGF-bb, and VEGF were observed in RRMS patients compared to controls. IL-2, IL-4, IL-12p70, PDGF, G-CSF, GM-CSF, and FGF-basic levels increased over time, while IL-10 decreased. IL-1β, IL-1RA, IL-6, TNF-α, and PDGF-bb levels negatively correlated with serum vitamin D. TNF-α levels positively correlated with post-contrast-enhancing brain lesions. IL-15 levels negatively correlated with T2 and Gd(+) lesions in C-spine MRI, while TNF-α, PDGF-bb, and FGF-basic correlated positively with T2 lesions in C-spine MRI. IL-6 levels positively correlated with post-contrast-enhancing lesions in Th-spine MRI. Distinct cytokine profiles in the CSF of de novo diagnosed MS patients provide insights into MS pathogenesis and guide immunomodulatory therapy strategies.

Introduction and objective: Known for their strong antioxidant properties, flavonoids are the major polyphenolic compounds found in a wide variety of plants, vegetables, and fruits. A growing number of reports has indicated their anticancer effect. Affecting numerous cellular pathways,...

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by demyelination, gliosis, and neurodegeneration. One of the most frequent and often initial manifestations of MS is optic neuritis (ON), occurring in about 25% of patients as the first symptom and in up to 50% during the disease course. The 2024 revision of the McDonald criteria introduced a major change by including the optic nerve as the fifth anatomical location demonstrating dissemination in space (DIS), thereby enhancing the diagnostic sensitivity of MS. Optic nerve involvement can now be confirmed through structural (magnetic resonance imaging [MRI], optical coherence tomography [OCT]) and functional tests (visual evoked potentials [VEP]), which allow detection of both clinical and subclinical demyelinating lesions. The diagnostic and classification framework proposed by Petzold et al. (2022) integrates clinical presentation, paraclinical evidence, and serological biomarkers, improving differentiation between autoimmune etiologies such as MS, neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The recognition of ON as an independent diagnostic region in the 2024 McDonald criteria represents a significant step forward in early MS diagnosis and in the initiation of disease-modifying therapies, ultimately improving long-term prognosis and patients’ quality of life. Keywords: multiple sclerosis neurology optic neuritis 2024 McDonald criteria

Rationale: Tick-borne encephalitis (TBE) can present with neurological symptoms mimicking Guillain-Barré syndrome (GBS), posing a significant diagnostic challenge. Misidentification may lead to delayed or inappropriate treatment, increasing the risk of complications. Patient concerns: A 49-year-old man presented with flu-like symptoms and progressive paralysis of the left upper limb following a tick bite. His condition rapidly deteriorated despite initial therapy, including facial nerve palsy, further paralysis of the left upper limb, and swallowing difficulties. Diagnoses: The initial clinical picture, cerebrospinal fluid analysis showing elevated protein, and electromyography suggested GBS. Interventions: The patient underwent 6 plasmapheresis sessions for suspected GBS, with no neurological improvement. Outcomes: Due to a lack of improvement and further magnetic resonance imaging findings, a repeated lumbar puncture and serological testing revealed the correct diagnosis of TBE, confirmed by the presence of IgM and IgG antibodies against the TBE virus. After stabilization and intensive care unit discharge, the patient was transferred to a neurology ward and later to a rehabilitation unit. Significant neurological improvement was observed, although partial left upper limb paresis and facial nerve palsy persisted. He was eventually discharged with continued outpatient neurology and cardiology follow-up. Lessons: This case highlights the importance of detailed medical history, including tick exposure, and maintaining a broad differential diagnosis in acute flaccid paralysis. Early consideration of infectious etiologies, particularly in endemic regions, is essential to prevent unnecessary interventions and improve patient outcomes.