Table 5.

CSF changes in acute demyelinating/inflammatory diseases

Condition	Clinical features	CSF findings
Transverse myelitis	Bilateral (not necessarily symmetric) sensorimotor and autonomic spinal cord dysfunction Clearly defined sensory level Hyperreflexia, babinski positive	Signs of inflammation (pleocytosis, elevated protein concentration, oligoclonal bands, or elevated IgG index) Elevated CSF IL-6 PCR negative of infections. CSF sugar, pressure usually normal.
Multiple sclerosis (different types)	Loss of sensation Muscle weakness Visual loss Incoordination, cognitive impairment Fatigue, pain Bladder and bowel disturbance	Pleocytosis (5–50 cells / cu mm; lymphocytes) Elevated protein OCB may be present. (highly diagnostic) Ig G index (increase CSF IgG compared to serum IgG levels)
Neuromyelitis optica	A severe transverse myelitis. An acute unilateral or bilateral optic neuropathy. No other clinical involvement.	Non specific Pleocytosis (5–50 cells/ cu mm; lymphocytes) Elevated protein OCB may be present. (most cases) Normal glucose levels
ADEM	Fever, meningeal signs, and acute encephalopathy The level of consciousness ranges from lethargy to frank coma. Maximum progression 4–7 days Common in children MRI diagnostic	Pleocytosis (5–50 cells/cu mm) and/or increased protein concentration May be normal CSF non diagnostic. Presence of oligoclonal band (OCB) favours diagnosis of MS
Guillain Barrie syndrome	Acute progressive weakness, areflexia, symmetry Post infection Autonomic dysfunction Cranial nerve involvement Mild sensory signs	Normal CSF cell count. Elevated CSF protein levels Cyto-albuminergic disassociation