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Table 10 Overview of routine CSF parameters and approximate frequency of pathological results in PML

From: S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Parameter 1st diagnostic lumbar puncture for PML Follow-up during therapy (IRIS) a Comment
Cell number ≤ 4/μL: 85%
≥ 5 - ≤ 50/μL: 10%
>  50/μL: 5%
May increase during IRIS Also dependent on the underlying disease and treatment.
Cell differentiation Normal or slightly activted. Lympho-monocytic   Also dependent on the underlying disease and treatment.
Total protein/ Albumin quotient Normal: 50%
Slightly elevated: 30%
Severely elevated: 20%
  
Quantitative IgG-, IgA-, IgM-synthesis IgG > 0%: 25%
IgA > 0%: 0%
IgM > 0%: 0%
  Is highly dependent on the underlying diseaseb
OCBs 42% b   Highly dependent on the underlying diseaseb
JCPyV-PCR Positive: 70-80% May increase during IRIS before it normalizes At first manifestation of PML:
Sensitivity: 60-90%
Specificity: 100%
  1. aEmpirical values from own experience due to the lack of published systematic data
  2. bValue from a study with primarily HIV-PML patients. In particular, the natalizumab-PML cases will show an intrathecal immunoglobulin synthesis and oligoclonal bands corresponding to the underlying multiple sclerosis