Can't pee, can't climb a tree: Seropositive myelin oligodendrocyte glycoprotein (MOG) antibodies in acute disseminated encephalomyelitis (ADEM).

When weighing the costs and benefits of "choosing wisely," in a healthcare climate that continues to stress cost-saving practices, it is difficult to argue with approaching low-risk patients with conservative approaches and treatments. In defense of liberal and broad approaches to patient workups, however, one must also weigh the bounce-back emergency department (ED) visit, which may represent either a failure of initial evaluation or a success of appropriate return precautions. An 18-year-old male presented to the ED with two days of urinary retention, abdominal pain, and subjective fever, was discharged with urology follow-up and doxycycline, and subsequently returned to the ED in <24 h with inability to stand and loss of reflexes in bilateral lower extremities. Magnetic Resonance Imaging (MRI) of the brain and spine demonstrated extensive and multifocal areas of signal abnormalities consistent with active demyelination concerning for acute disseminated encephalomyelitis (ADEM). Additional lab workup demonstrated seropositive myelin oligodendrocyte glycoprotein (MOG) antibodies, further supporting the diagnosis of ADEM, an immune-mediated disorder which can lead to rapid multifocal neurologic dysfunction.

Different Neuronal Activity Patterns Induce Different Gene Expression Programs.

A vast number of different neuronal activity patterns could each induce a different set of activity-regulated genes. Mapping this coupling between activity pattern and gene induction would allow inference of a neuron's activity-pattern history from its gene expression and improve our understanding of activity-pattern-dependent synaptic plasticity. In genome-scale experiments comparing brief and sustained activity patterns, we reveal that activity-duration history can be inferred from gene expression profiles. Brief activity selectively induces a small subset of the activity-regulated gene program that corresponds to the first of three temporal waves of genes induced by sustained activity. Induction of these first-wave genes is mechanistically distinct from that of the later waves because it requires MAPK/ERK signaling but does not require de novo translation. Thus, the same mechanisms that establish the multi-wave temporal structure of gene induction also enable different gene sets to be induced by different activity durations.