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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 95 OF 100
Which of the following CSF findings is more suggestive of a neuromyelitis optica spectrum disorder than relapsing-remitting multiple sclerosis?
A. Low glucose
B. High protein
C. Mild lymphocytic pleocytosis
D. Absence of oligoclonal bands
E. Low glial fibrillary acidic protein **
** = Your answer
Patients with neuromyelitis optica (NMO) spectrum disorder and multiple sclerosis (MS) often have different CSF patterns, but no single finding is specific or sensitive, and all results should be interpreted in context. Patients with both conditions can have elevated CSF protein levels or a mild pleocytosis, although patients with NMO-spectrum disorders tend to have more neutrophils than lymphocytes. CSF glucose is unlikely to be affected in either condition. Elevated GFAP levels are reported in NMO over MS. Oligoclonal bands can be present in up to 25% of patients with acute relapses of NMO spectrum disorder, but they are much more common in patients with MS; therefore, their absence should raise suspicion for another disorder.
* Katz Sand I. Neuromyelitis optica spectrum disorders. Continuum Lifelong Learning Neurol. 2016;22(3):864-896.
* Kazuo Fujihara, Tatsuro Misu, Ichiro Nakashima, Toshiyuki Takahashi, et al.Neuromyelitis optica should be classified as an astrocytopathicdisease rather than a demyelinating disease. Clinical and Experimental Neuroimmunology 3 (2012) 58–73.