What is the role of CSF analysis in the workup of neurosarcoidosis?

Updated: Nov 13, 2018
  • Author: Gabriel Bucurescu, MD, MS; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

When the involvement is purely peripheral (eg, diffuse peripheral neuropathy or myopathy), the CSF findings are normal. CSF examination shows a nonspecific pattern of pleocytosis and elevated protein (>0.5 g/L) if the root sheaths or meninges are involved. Glucose levels may be normal or low. In one study of 68 patients, the CSF leukocyte count was in the range of 5-220 cells/µL. These CSF findings, coupled with negative cytology and culture results, support the diagnosis of neurosarcoidosis.

levels of angiotensin-converting enzyme (ACE), lysozyme, and beta2-microglobulin can be elevated in the CSF in more than half the patients; changes in these markers can parallel the clinical course. The ACE level is rarely elevated in isolated neuropathy but may be elevated in systemic sarcoidosis.

High IgG, Ig index, and oligoclonal bands have been reported in the CSF. Studies of subpopulations of T lymphocytes have shown a high T4/T8 ratio, which can help in differentiating sarcoidosis from multiple sclerosis.

A recent study reported elevated levels of soluble CSF interleukin 2 receptor (sIL2-R) in patients with neurosarcoidosis, suggesting this as a possible marker for the diagnosis of the disease and for treatment and follow up of disease activity. [29]


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