Distinguishing neurosarcoidosis from multiple sclerosis based on CSF analysis

Neurology ◽  
2020 ◽  
Vol 94 (24) ◽  
pp. e2545-e2554
Author(s):  
Tarunya Arun ◽  
Laura Pattison ◽  
Jacqueline Palace
Keyword(s):  
Multiple Sclerosis ◽  
Cell Count ◽  
Total Protein ◽  
White Cell Count ◽  
Binary Logistic Regression ◽  
White Cell ◽  
Oligoclonal Bands ◽  
Csf Analysis ◽  
Elevated Protein ◽  
Oligoclonal Igg

ObjectiveTo characterize a cohort of patients with neurosarcoidosis with particular focus on CSF analysis and to investigate whether CSF values could help in distinguishing it from multiple sclerosis (MS).MethodsThis retrospective cohort study enrolled 85 patients with a diagnosis of neurosarcoidosis (possible, probable, or definite). CSF total protein, white cell count, and angiotensin-converting enzyme levels were measured. CSF and serum oligoclonal immunoglobulin G (IgG) patterns were analyzed with the use of odds ratios and binary logistic regression.ResultsEighty patients had a probable (nonneural positive histology) or definite (neural positive histology) diagnosis of neurosarcoidosis. Most frequent findings on MRI were leptomeningeal enhancement (35%) and white matter and spinal cord involvement (30% and 23%). PET scan showed avid areas in 74% of cases. CSF analysis frequently showed lymphocytosis (63%) and elevated protein (62%), but CSF-selective oligoclonal bands were rare (3%). Serum ACE levels were elevated in 51% of patients but in only 14% of those with isolated neurosarcoidosis. Elevated CSF ACE was not found in any patient.ConclusionsLarge elevations in total protein, white cell count, and serum ACE occur in neurosarcoidosis but are rare in MS. The diagnostic use of these tests is, however, limited because minimal changes may occur in both. MS clinical mimics in neurosarcoidosis are not common, and intrathecal synthesis of oligoclonal IgG is a powerful discriminator because it is rare in neurosarcoidosis but occurs in 95% to 98% cases of MS. We suggest caution in making a diagnosis of neurosarcoidosis when intrathecal oligoclonal IgG synthesis is found.

scholarly journals STUDIES ON ACUTE DISSEMINATED ENCEPHALOMYELITIS PRODUCED EXPERIMENTALLY IN RHESUS MONKEYS

1951 ◽  
Vol 93 (6) ◽  
pp. 615-633 ◽  
Author(s):  
Elvin A. Kabat ◽  
Abner Wolf ◽  
Ada E. Bezer ◽  
Jean P. Murray
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Rhesus Monkey ◽  
Cell Count ◽  
Total Protein ◽  
Rhesus Monkeys ◽  
Gamma Globulin ◽  
White Cell Count ◽  
Acute Disseminated Encephalomyelitis ◽  
White Cell

The white cell count, total protein, gamma globulin, and percentage of gamma globulin in the cerebrospinal fluid of monkeys with acute disseminated encephalomyelitis produced by the injection of brain emulsions with adjuvants have been studied. The acute phase of the disease is characterized by a rise in the white cell count, total protein, and gamma globulin in the cerebrospinal fluid. In some instances the percentage of gamma globulin, to the total protein may be normal while in others it is elevated. As the acute process subsides, the total protein declines and animals frequently show an increase in the percentage of gamma globulin to total protein. The relation of the cerebrospinal fluid findings in acute disseminated encephalomyelitis in the rhesus monkey to those in human multiple sclerosis is discussed.

Pragmatic and evidence-based approach to paediatric cerebrospinal fluid reference limits for white cell count and concentrations of total protein and glucose

2018 ◽  
Vol 71 (10) ◽  
pp. 932-935 ◽  
Author(s):  
Nicky Josman ◽  
Nancy W S Tee ◽  
Matthias Maiwald ◽  
Liat Hui Loo ◽  
Clement K M Ho
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Total Protein ◽  
Clinical Laboratory ◽  
White Cell Count ◽  
Reference Intervals ◽  
White Cell ◽  
Invasive Procedures ◽  
Paediatric Hospital ◽  
Reference Limits

BackgroundIt is often impractical for each laboratory to establish its own paediatric reference intervals. This is particularly true for specimen types collected using invasive procedures, for example, cerebrospinal fluid (CSF).MethodsPublished CSF reference intervals for white cell count, and concentrations of total protein and glucose were reviewed by stakeholders in a paediatric hospital. Consensus reference intervals for the three CSF parameters were then subjected to verification using guidelines from the Clinical Laboratory Standards Institute and residual CSF specimens.ResultsConsensus paediatric reference intervals adapted from published studies with minor modifications were locally verified as follows. White cell count (x106 cells/L): 0–20 (<1 month); 0–10 (1–2 months); 0–5 (>2 months). Total protein (g/L): 0.3–1.2 (<1 month); 0.2–0.6 (1–3 months); 0.1–0.4 (>3 months). Glucose (mmol/L): 2.0–5.6 (<6 months); 2.4–4.3 (6 months or older).

Leucocytes and Thrombosis

1973 ◽  
Vol 30 (01) ◽  
pp. 036-046 ◽  
Author(s):  
D.C Banks ◽  
J.R.A Mitchell
Keyword(s):  
Cell Count ◽  
White Cell Count ◽  
Cell Loss ◽  
White Cell ◽  
Structural Resemblance ◽  
The Masses

SummaryWhen heparinised blood is rotated in a glass flask at 37°C. the white cell count falls and it has been shown that this is due to the adherence and aggregation of polymorphonuclear white cells on the wall of the flask. The masses formed bear a close structural resemblance to thrombi and the mechanisms involved in white cell loss during rotation may therefore increase our knowledge of the thrombotic process.

An Assessment of Red Cell Deformability Using a Simple Filtration Method

1979 ◽  
Author(s):  
M Drummond ◽  
G Lowe ◽  
J Belch ◽  
C Forbes ◽  
J Barbenel
Keyword(s):  
Cell Count ◽  
Shear Viscosity ◽  
White Cell Count ◽  
White Cell ◽  
Red Cell ◽  
Cell Deformability ◽  
Red Cell Deformability ◽  
Simple Method ◽  
Filtration Method ◽  
Significant Difference

We investigated the reproducibility and validity of a simple method of measuring red cell deformability (filtration of whole blood through 5 µ sieves) and its relationship to haematocrit, blood viscosity, fibrinogen, white cell count, sex and smoking. The mean coefficient of variation in normals was 3. 7%. Tanned red cells showed marked loss of deformability. Blood filtration rate correlated with haematocrit (r = 0. 99 on dilution of samples, r = 0. 7 in 120 normals and patients). After correction for haematocrit, deformability correlated with high shear viscosity, but not low shear viscosity, fibrinogen or white cell count. In 60 normals there was no significant difference between males and females, or smokers and non-smokers, but in 11 smokers there was an acute fall in deformability after smoking 3 cigarettes (p<0. 05). Reduced deformability was found in acute myocardial infarction (n = 15, p<0. 01) and chronic peripheral arterial disease (n = 15, p<0. 01). The technique is reproducible, detects rigid cells and appears useful in the study of vascular disease.

scholarly journals The use of routine blood tests to assist the diagnosis of COVID-19 in symptomatic hospitalized patients

2021 ◽  
pp. 000456322199907
Author(s):  
IT Parsons ◽  
AT Parsons ◽  
E Balme ◽  
G Hazell ◽  
R Gifford ◽  
...  
Keyword(s):  
Cell Count ◽  
Retrospective Review ◽  
Blood Test ◽  
Patient Flow ◽  
White Cell Count ◽  
Area Under The Curve ◽  
White Cell ◽  
Test Results ◽  
Rt Pcr ◽  
Blood Tests

Introduction Specific patterns of blood test results are associated with COVID-19 infection. The aim of this study was to identify which blood tests could be used to assist in diagnosing COVID-19. Method A retrospective review was performed on consecutive patients referred to hospital with a clinical suspicion of COVID-19 over a period of four weeks. The patient’s clinical presentation and severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction (SARS-CoV-2 RT-PCR) were recorded. The patients were divided by diagnosis into COVID (COVID-19 infection) or CONTROL (an alternate diagnosis). A retrospective review of consecutive patients over a further two-week period was used for the purposes of validation. Results Overall, 399 patients (53% COVID, 47% CONTROL) were analysed. White cell count, neutrophils and lymphocytes were significantly lower, while lactate dehydrogenase and ferritin were significantly higher, in the COVID group in comparison to CONTROL. Combining the white cell count, lymphocytes and ferritin results into a COVID Combined Blood Test (CCBT) had an area under the curve of 0.79. Using a threshold CCBT of –0.8 resulted in a sensitivity of 0.85 and a specificity of 0.63. Analysing this against a further retrospective review of 181 suspected COVID-19 patients, using the same CCBT threshold, resulted in a sensitivity of 0.73 and a specificity of 0.75. The sensitivity was comparable to the SARS-CoV-2 RT PCR. Discussion Mathematically combining the blood tests has the potential to assist clinical acumen allowing for rapid streaming and more accurate patient flow pending definitive diagnosis. This may be of particular use in low-resource settings.

A study in correlation of the sedimentation test, filament-nonfilament, and the white cell count in gynecology

1933 ◽  
Vol 25 (2) ◽  
pp. 203-212 ◽  
Author(s):  
H. Wellington Yates ◽  
David M. Davidow ◽  
Elizabeth Putnam ◽  
Frances Ellman
Keyword(s):  
Cell Count ◽  
White Cell Count ◽  
White Cell
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