Table 1.
Months from onset | Cells/μl CSF | Total protein mg/dl | IgG anti-Ca titers (IHC) | QIgG anti-Ca | IgG total mg/dl | QIgG | IgM total mg/dl | QIgM | Albumin total mg/dl | QAlb | Qlim | AI anti-Ca | OCBs CSF/serum | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CSF | Serum | CSF | Serum | CSF | Serum | CSF | Serum | ||||||||||
0 | 44 ↑ | 48 ↑ | 1:2000 | 1:6000 | 333.3 | 7.66 | 1190 | 6.44 | 0.567 | 267 | 2.12 | 25.1 | 3770 | 6.66 | 4.89 | 68.2 | Pos/neg |
Interventions: | 3 × 1000 mg methylprednisolone (MP) intravenously followed by oral therapy over 3 weeks at an initial dose of 60 mg MP, resulting in marked neurological improvement. After tapering corticosteroids to 12.5 mg MP per day the patient experienced worsening of symptoms together with an exaggerated startle response (month 2). | ||||||||||||||||
2 | 1 | 31 | N.d. | N.d. | N.d. | 3 | 813 | 3.69 | 0.086 | 296 | 0.29 | 10.4 | 4410 | 2.36 | 1.46 | N.d. | N.d. |
Interventions: | 5 × 500 mg methylprednisolone (MP) intravenously (month 3) and 5 × 500 mg methylprednisolone (MP) intravenously + intravenous immunoglobulins (month 4), followed by only slight and transient neurological improvement. Oral therapy with MP at an initial dose of 60 mg MP. | ||||||||||||||||
5 | 2 | 25 | 1:200 | 1:7000 | 28.6 | 1.9 | 927 | 2.05 | 0.065 | 251 | 0.26 | 14.7 | 3950 | 3.72 | 2.44 | 11.7 | Pos/neg |
Interventions: | Plasma exchange at month 6 (after progressive neurological deterioration), followed by clinical stabilization and moderate improvement. |
AI = antibody index (see method section for details); CSF = cerebrospinal fluid; IHC = immunohistochemistry; QIgG = IgG CSF/serum ratio; QIgM = IgM CSF/serum ratio; QAlb = albumin CSF/serum ratio; Qlim = upper reference range for IgG, albumin-dependent (see method section for details); OCB = oligoclonal bands.