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) | 30% | |
Intrathecal IgG, IgA, IgM synthesis | QIgG > Qlim: 8% QIgA > Qlim: 6% QigM > Qlim: 13% | 0% 0% 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% | |
MOG-EM | |||
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): | >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 | |