Multiple sclerosis, differential diagnosis

Stourac, R, and Bednafova, J., Intrathecal, antiviral and oligoclonal IgG synthesis in multiple sclerosis and its significance in differential diagnosis of neurological diseases. Clin. Biochem. Metab. 8(29), 204-208 (2000). 

Differential Diagnosis of Multiple Sclerosis Halim Fadil, Roger E. Kelley, and EAuardo Gonzalez-Toledo... 

Rolak LA, Fleming JO (2007). The differential diagnosis of multiple sclerosis. Neurologist 13 57-72... 

There are many examples of CNS diseases where a combination of more than one CSF parameter significantly improves the accuracy of the diagnosis. Neuro-inflammatory diseases, like neuroborreliosis (Tumani et al., 1995) or multiple sclerosis (Reiber et al., 1998) are representative examples. Similarly, studies have been reported showing increased sensitivity and specificity of a combination of CSF parameters in early and differential diagnoses of AD. 

Matthews B (1998) Differential diagnosis of multiple sclerosis and related disorders. In McAlpines Multiple Sclerosis (Compston A, Ebers G, Lassmann H, McDonald I, Matthews B, Wekerle H, eds), pp 223-250. London Harcout Brace and Co. Ltd. 

MR spectroscopy is used extensively in clinical practice to help differentiate tumor from non-tumor lesions in the brain. The Cho/Cr and NAA/Cho ratios can be utilized to help accomplish this task (Poptani et al., 1995 Moller-Hartmann et al., 2002). Increased Cho/Cr and decreased NAA/Cho are positive inidications of a brain tumor (Poptani et al., 1995 Moller-Hartmann et al., 2002). The lipid and lactate peaks are more variable in tumor and non-tumor lesions but can also aid in tumor diagnosis. There are a number of disease processes, such as multiple sclerosis plaques, that cannot always be differentiated by spectroscopy from a brain tumor. 

Perhaps the most important reason for analyzing CSF is as part of the differential diagnosis of brain inflammation. This inflammation can be either acute or chronic. Probably the most common cause of chronic brain inflammation is multiple sclerosis. About 90-95% of patients with multiple sclerosis will have a typical pattern of immimoglobulin bands called oligoclonaP in their CSF, which are not found in the corresponding serum when analyzed by isoelectric focusing. As there are various treatments for multiple sclerosis, these can be monitored by longitudinal lumbar puncture to ascertain whether the brain lymphocytes have been suppressed in their production of IgG. 

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