Cerebrospinal fluid immunoglobulin abnormalities in neurosarcoidosis
S. J. Borucki, B. V. Nguyen, C. T. Ladoulis and R. R. McKendall
Department of Neurology, University of Texas Medical Branch, Galveston 77550.
A retrospective chart review of neurosarcoidosis at the University of Texas
Medical Branch (Galveston) between 1982 and 1987 revealed 99 patients with
sarcoidosis. Six patients were diagnosed with neurosarcoidosis and had
electrophoresis of serum and cerebrospinal fluid performed (one patient
with a ventriculoperitoneal shunt was later excluded). Cerebrospinal fluid
immunoglobulins and albumin levels were determined followed by calculation
of an IgG index and synthesis rate for each patient. Four (80%) of five
patients had elevated IgG indexes and synthesis rates indicative of
intrathecal immunoglobulin production. No patient had immunoglobulin
oligoclonal bands detected. To date, results of electrophoresis of
cerebrospinal fluid in neurosarcoidosis have been reported in 37 patients
among four series. Of these, only nine patients (24%) have had either an
elevated IgG index or synthesis rate. Our series suggests that intrathecal
immunoglobulin production in neurosarcoidosis occurs more frequently than
previously described. Furthermore, the elevated indexes and synthesis rates
without associated oligoclonal bands suggests a polyclonal immunoglobulin
response.
