Skip to main content

Table 16 Overview of relevant CSF parameters and frequency of abnormalities during relapse and in remission

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

Parameter Relapse Remission Remarks
NMOSD with AQP4-IgGa
 Cell count > 4/μL: ca. 60 - 78%
> 100/μL: ca. 6%
Mostly normal (> 5/μL: 20%; > 100/μL: 0%) Negative correlation between cell count and time (in days) since onset of relapse
 Cell profile - lymphocytes and monocytes (97% of cells)
- neutrophils in 40-60% (rarely dominant cell population)
- eosinophils in 10-15%
- basophils in 2-4%
- activated lymphocytes or
- plasma cells in up to 20% (up to approximately 15% of all cells)
Less pathologically altered to normalized  
 Albumin quotient Increased in 55%
(mostly 8-25, rarely > 25)
 Intrathecal IgG, IgA, IgM synthesis QIgG > Qlim: 8% QIgA > Qlim: 6% QigM > Qlim: 13% 0%
 OCB CSF-restricted OCB (type 2 or type 3): 20-30% 9% No significant difference between AQP4-IgG-positive and AQP4-IgG-negative patients
 MRZ reaction
AI ≥1.5 for at least two of the viruses
Almost always negative Almost always negative  
 Lactate 43% ~ 0%  
 Cell count ≤5/μL:30-67%
> 5/μL:33-70%
> 100/μL6-28%
  see a
 Cell profile - lymphocytes and monocytes
- plus neutrophils in 64% of cases with pleocytosis
  Pleocytosis more frequent in patients with myelitis as first manifestation
 Albumin quotient
>Qlim(Alb):32%   More common in patients with myelitis or brain stem encephalitis
 Intrathecal IgG, IgA, IgM synthesis QIgG >Qlim: 7%   Investigated in one study only
 OCBs CSF-restricted OCB (type 2 or type 3): 6-22%   
 MRZ reaction
AI ≥1,5
Negative   Investigated in a small cohort only
  1. aIn NMOSD with AQP4-IgG cell count, QAlb, QIgG, total protein, and lactate are more frequently increased and the increase is more pronounced in acute myelitis than in acute optic neuritis