Intrathecal production of oligoclonal IgM and IgG in CNS sarcoidosis

Kinnman, J.; Link, Hans

doi:10.1111/j.1600-0404.1984.tb07785.x

Cited by 31 publications

(6 citation statements)

References 22 publications

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“…12 Aseptic meningitis, characterized by headache, meningismus, and a CSF lymphocytic pleocytosis, may be a recurrent problem in patients with neurosarcoidosis. 12 The CSF abnormalities in sarcoidosis are nonspecific and are as follows: (1) lymphocytic pleocytosis, (2) elevated protein concentration, (3) decreased glucose concentration, (4) elevated IgG index and synthesis rate indicative of intrathecal immunoglobulin production, [14][15] (5) oligoclonal banding, 15,16 and (6) elevated CSF angiotensin-converting enzyme (ACE). ACE is produced in the epithelioid and giant cells of sarcoid granulomas, which are usually widespread throughout the meninges.…”

Section: Sarcoidosis Sarcoidosis Is a Multisystemmentioning

confidence: 99%

Mycobacterium tuberculosis Meningitis and Other Etiologies of the Aseptic Meningitis Syndrome

Roos

2000

Semin Neurol

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Mycobacterium tuberculosis is one of the most common infectious agents in the world. It causes an insidious form of meningitis characterized by headache, low-grade fever, stiff neck and cranial nerve palsies, and an acute meningoencephalitis characterized by coma, raised intracranial pressure, seizures, and focal neurological deficits. This review focuses on the diagnosis and therapy of the insidious form of tuberculous meningitis and discusses the differential diagnosis of infectious and noninfectious etiologies of the aseptic meningitis syndrome.

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Section: Sarcoidosis Sarcoidosis Is a Multisystemmentioning

confidence: 99%

Mycobacterium tuberculosis Meningitis and Other Etiologies of the Aseptic Meningitis Syndrome

Roos

2000

Semin Neurol

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“…There has been one exceptional case reported Fig. 1; CSF sIL-2R was not detectable with oligoclonal IgM and IgG bands in CSF persisting after steroid treatment and clinical remission [7]. Also, in a recent study of 7 cases, oligoclonal bands in CSF were detected in 2 patients with normal IgG indices [20], however, the authors failed to state whether bands were also positive in the parallel serum samples, which would indicate an unselective B-cell activation.…”

Section: Discussionmentioning

confidence: 95%

Neurosarcoidosis without systemic sarcoidosis

Sommer

Weller

Petersen

et al. 1991

Eur Arch Psychiatry Clin Nuerosci

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Neurosarcoidosis is a well-recognised complication of systemic sarcoidosis but diagnosis may be difficult if there is no clear evidence of an extracerebral manifestation of the disease. We present the case of a 42-year-old woman with clinical features characteristic of cerebral sarcoidosis including tetraparesis, diabetes insipidus, diencephalic hyperphagia, personality changes, and memory loss. Diagnosis was supported by cerebrospinal fluid (CSF) findings and magnetic resonance imaging (MRI): CSF showed mild lymphocytic pleocytosis, intrathecal production of IgG without oligoclonal bands, and a raised level of lysozyme. MRI revealed multiple contrast-enhanced granulomas at the base of the brain with partial involvement of diencephalic and mesencephalic structures and parts of the spinal cord. There was no evidence of systemic manifestation of sarcoidosis. Administration of corticosteroids led to improvement of the symptoms.

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“…Agarose electrophoresis, however, is less sensitive than isoelectric focusing for detecting oligoclonal IgG. Studies using iso-electric focusing have detected intrathecal synthesis among 1/1 (Kinnman and Link 1984), 2/3 (Kinnman andLink 1984) and7/19 (McLean, Mitchell, and cases. Given the important effect of inclusion criteria upon findings, the different incidences of intrathecal synthesis among published series may simply reflect different inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

New Evidence-Based Diagnostic Criteria for Neurosarcoidosis

Chamoun¹,

Thompson²,

Giovannoni³

2023

Preprint

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Background: Neurosarcoidosis is a great mimic, and its distinction from multiple sclerosis and other disorders can be particularly troublesome. We investigated whether cerebrospinal fluid (CSF) examination could help distinguish these two conditions and propose new diagnostic criteria. Methods: Stringent hierarchical diagnostic criteria were formulated. These were then applied prospectively to 531 neurological patients in whom neurosarcoidosis entered the differential diagnosis. The CSF total protein (TP), white cell count (WCC) and angiotensin-converting enzyme (ACE) levels were measured. The CSF and serum IgG patterns after isoelectric focusing were compared. Not all CSF parameters were measured in every patient. Results: 85/531 (16%) cases examined were diagnosed with neurosarcoidosis. Only 22 of these 85 (26%) met stringent diagnostic criteria. Intrathecal synthesis of oligoclonal IgG was evident in only 1/19 (5%) who fulfilled these criteria compared to 19/59 (32%) cases who did not (p = 0.03). CSF TP levels > 1g/L were more common in patients meeting the stringent criteria compared to the remainder of the patients, i.e. 11/22 (50%) vs 14/58 (24%) (p<0.05). Eleven out of 20 cases (55%) fulfilling stringent criteria had elevated CSF WCCs, and 6/12 cases (50%) had raised CSF ACE, neither significantly different from the remaining cases. Mean CSF TP, WCC, and ACE levels did not differ significantly between any groups of patients. Interpretation: Large elevations in CSF total protein, white cell count, and ACE occur in neurosarcoidosis but are rare in multiple sclerosis. However, the diagnostic use of these tests is limited since minimal changes may occur in both conditions. In contrast, intrathecal synthesis of oligoclonal IgG is a powerful discriminator because it is very uncommon in neurosarcoidosis whilst occurring in 95-98% of cases of multiple sclerosis. This observation implies that the immunopathogenesis of the two disorders is quite different. We suggest caution in diagnosing neurosarcoidosis when intrathecal oligoclonal IgG synthesis is detected. We propose new diagnostic criteria for neurosarcoidosis for future research.

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Intrathecal production of oligoclonal IgM and IgG in CNS sarcoidosis

Cited by 31 publications

References 22 publications

Mycobacterium tuberculosis Meningitis and Other Etiologies of the Aseptic Meningitis Syndrome

Mycobacterium tuberculosis Meningitis and Other Etiologies of the Aseptic Meningitis Syndrome

Neurosarcoidosis without systemic sarcoidosis

New Evidence-Based Diagnostic Criteria for Neurosarcoidosis

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