2025 American Academy of Neurology Abstract Website

Objective:

To compare the proportions of immune cells in CSF among patients with neurosarcoidosis (NS) and multiple sclerosis (MS).

Background:

MS and NS have different pathogenesis but overlap in their clinical presentations and cerebrospinal fluid (CSF) findings. We hypothesized that immune cell profiles and CD4/CD8 ratios in CSF may help differentiate the two disorders.

Design/Methods:

NS patients evaluated at NYU MS Care Center with available CSF flow were age-, sex-, and race/ethnicity- matched to patients with MS. Proportions of immune cells in CSF were analyzed with flow cytometry (BD FACSCanto™ and FACSCanto™ II Cell Analyzers, BDBiosciences, San Jose, CA) and manually verified by a board-certified hematopathologist.

Results:

19 patients with NS had available CSF flow cytometry (age: 55.9±10.8 years; 68% female; 63% African American; 68% on immunomodulatory medication at the time of CSF collection). Compared to matched MS patients, the patients with NS had significantly higher leukocyte count in CSF (60.8±116.3 v. 2.1±2.6 cells/mm³, p=0.034), higher protein (124.5±129.0 v. 35.7±19.6 mg/dL, p= 0.0053), and lower number of CSF-restricted oligoclonal bands (1.7±2.4 v. 7.7±5.2, p=0.0001), while glucose and IgG index were similar. On CSF flow cytometry, NS patients had 77%±17% small T-lymphocytes, v. 80%±11% in MS (p=0.52); 3%±4% small mature B lymphocytes, v. 2%±2% for MS (p=0.34); 4%±3% NK cells, v. 3%±5% in MS (p=0.46); 9%±12% monocytes, v. 9%±8% for MS (p=1.0). CD4/CD8 ratio in NS - 4.2:1±1.6:1 - was non-significantly higher than in MS - 3.3:1±1.4:1 (p=0.09). Kappa/lambda ratios in NS and MS were very similar: 1.6:1±0.5:1 v. 1.5:1±0.6 in MS (p=0.51).

Conclusions:

CSF of NS patients differed from MS in total leukocyte count, protein and OCB, but not in the proportion of immune cells. Neither the CD4/CD8 ratio nor the proportion of mature B lymphocytes helped discriminate between the two diseases.