What is the role of cerebrospinal fluid analysis in the workup of optic neuritis in multiple sclerosis (MS)?

Updated: Feb 21, 2019
  • Author: Fiona Costello, MD, FRCP; Chief Editor: Hampton Roy, Sr, MD  more...
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Answer

Answer

Cerebrospinal fluid analysis is not generally required to diagnose typical cases of optic neuritis. As MRI has assumed a greater role in determining the immediate and future risk of MS in patients with optic neuritis, lumbar puncture has fallen somewhat out of favor. That said, CSF analysis still plays an important diagnostic role in atypical cases of optic neuritis, such as suspected infectious optic neuropathies secondary to syphilis, tuberculosis, or Lyme disease. Moreover, CSF markers have predictive value in determining the future risk of MS in some patients. In a 2015 study of 357 children with isolated optic neuritis, positive oligoclonal bands in the CSF and abnormal cranial MRI findings conferred a 27-fold higher hazard ratio for developing MS compared to double-negative findings. [22]


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