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Distinguishing neurosarcoidosis from multiple sclerosis based on CSF analysis: A retrospective study
Tarunya Arun1, Laura Pattison2, Jacqueline Palace2
1From the University Hospitals of Coventry and Warwickshire (T.A., L.P.); and Oxford University Hospitals (J.P.), Oxford, UK. tarunya.arun@uhcw.nhs.uk.
Neurology
|May 2, 2020
Summary
Neurosarcoidosis often shows elevated CSF protein and white cells, but these are not definitive. Intrathecal oligoclonal IgG synthesis is rare in neurosarcoidosis, making it a key differentiator from multiple sclerosis (MS).
Area of Science:
- Neurology
- Immunology
- Clinical Diagnostics
Background:
- Neurosarcoidosis diagnosis can be challenging, often overlapping with other neurological conditions.
- Cerebrospinal fluid (CSF) analysis is crucial for diagnosing neuroinflammatory disorders.
- Distinguishing neurosarcoidosis from multiple sclerosis (MS) requires careful evaluation of various biomarkers.
Purpose of the Study:
- To characterize neurosarcoidosis patients focusing on CSF findings.
- To determine if CSF analysis can differentiate neurosarcoidosis from MS.
- To evaluate the utility of specific CSF markers in diagnosing neurosarcoidosis.
Main Methods:
- Retrospective cohort study of 85 neurosarcoidosis patients.
- Analysis of CSF total protein, white cell count, and angiotensin-converting enzyme (ACE).
- Assessment of CSF and serum oligoclonal immunoglobulin G (IgG) patterns using logistic regression.
Main Results:
- CSF analysis revealed lymphocytosis (63%) and elevated protein (62%) in neurosarcoidosis.
- CSF-selective oligoclonal IgG bands were rare (3%), contrasting with MS.
- Elevated serum ACE was observed in 51% of patients, but CSF ACE was not elevated.
Conclusions:
- Elevated CSF protein and white cells are common in neurosarcoidosis but can occur in MS.
- Intrathecal oligoclonal IgG synthesis is a strong discriminator, being rare in neurosarcoidosis but common in MS.
- Caution is advised when diagnosing neurosarcoidosis in the presence of intrathecal oligoclonal IgG synthesis.
