![]() ![]() It reaches its maximal value in the differential diagnosis only when other rare causes of CNS inflammation have been excluded. The detection of CSF oligoclonal bands by isoelectric focusing is not absolutely specific for multiple sclerosis. The oligoclonal bands resolved by IEF are visualized by IgG-specific antibody staining. Serum immunoglobulins are also present in low concentration in the CSF and in order to reliably discriminate between locally (CNS) synthesised and systemically synthesised immunoglobulins it is necessary to analyse both serum and CSF collected from a patient at the same time. They are secreted into the CSF and can be detected using isoelectric focusing (IEF) in combination with Western blotting. ![]() Oligoclonal bands are IgG immunoglobulins secreted by plasma cells that are resident within the CNS in multiple sclerosis. In a very high proportion of patients with multiple sclerosis (>90%) the CSF contains oligoclonal bands that are not present in the serum. The clinical diagnosis of multiple sclerosis can be supported by analysis of cerebrospinal fluid (CSF). Although this patient presented with an intracerebral arachnoid cyst that can act epileptogenic per se, the combination of prolonged postictal encephalopathy with unresponsiveness to antiepileptic measures, absence of focal epileptiform activity on EEG, response to corticoids and serum NMDA-R antibody positivity favours the diagnosis of autoimmune NMDA-R encephalitis in this case.Detection of oligoclonal bands in the cerebrospinal fluid and serum The patient gradually recovered and, in retrospect, elevated serum N-methyl- d-aspartic acid-receptor (NMDA-R) antibodies were detected. Subsequently, intravenous corticoids were administered to exclude the contribution of an underlying autoimmune encephalopathy. Despite restoration of euthyroidism and administration of antiepileptic and antiviral drugs, neurological features persisted. Neuroimaging revealed the presence of a congenital arachnoid cyst in the right temporal lobe. Cerebrospinal fluid analysis showed oligoclonal banding in the absence of pleocytosis, thyroid peroxidase antibodies or infection. Laboratory examination demonstrated a suppressed thyroid-stimulating hormone level with dramatically elevated free triiodothyronine, free thyroxine and thyroid-stimulating immunoglobulins. A 16-year-old girl with a history of Graves’ disease presented with two episodes of generalised tonic-clonic seizures, necessitating intensive care admission. ![]()
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May 2023
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