Cerebrospinal fluid pleocytosis in multiple sclerosis patients with lesions showing reduced diffusion

This study looked at the cerebrospinal fluid (CSF) findings in patients with acute relapses presenting with acute MRI lesions with and without reduction of the apparent diffusion coefficient (ADC). Newly developing lesions in MS show reduced diffusion, but the exact mechanisms contributing to the reduction of diffusion in MS lesions in not well understood.

The study included 25 patients with MS or a clinically isolated syndrome later confirmed as MS. CSF analysis was carried out within 24 hours of the MRI scan and before treatment was started.

Results showed that, in nine of the 25 cases included in the study, a reduced value of the ADC was present with an associated pleocytosis in the CSF at >10 leucocytes/µl. Of the remaining 16 subjects included in the study, there was no reduction of the ADC and the CSF showed no or only a mild pleocytosis < 10 leucocytes/µl.

Therefore this study demonstrates that the presence of acute lesions with reduced diffusion is often associated with high CSF cell counts. The reduced diffusion is an early transient event which tends to evolve quite rapidly. The mechanisms behind the reduction of diffusion are not fully understood but one potential mechanism is a reduction of water molecule diffusion, which may indicate cytotoxic cell swelling as a result of failure of energy metabolism.

Authors: Eisele P, Szabo K
Source: Mult Scler. 2013 Dec 9. [Epub ahead of print]
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