1. Monday, November 19, 2018
BANDING PATTERNS IDENTIFIED IN THE ISOLECTRIC FOCUSING OF CEREBROSPINAL FLUID WITH COMPARATIVE SERUM SAMPLES
The main purpose of spectroscopic examination of CSF is to determine if there has been subarachnoid haemorrhage. Blood entering the CSF begins to breakdown within an hour or two liberating haemoglobin, and by 12 hours there has been significant breakdown of haemoglobin to bilirubin. Bilirubin and haemoglobin can be distinguished by their spectral properties. It is important not to perform the lumbar puncture less than twelve hours after the onset of the suspected bleeding event. If it is done too soon it will impossible to differentiate between a spontaneous subarachnoid haemorrhage and that from a traumatic lumbar puncture.
CSF Working Party
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2. TYPE 1 POLYCLONAL RESPONSE IN CSF (No bands visible in the CSF track)
Monday, November 19, 2018
TYPE 1 POLYCLONAL RESPONSE IN CSF (No bands visible in the CSF track)
Serum
The main types of banding that will be encounted when identifying patterns include a normal polyclonal response.
There are at present 5 pattern types generally recognised.
Here is a normal polyclonal response.
CSF
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3. Monday, November 19, 2018
TYPE 2 OLIGOCLONAL CSF (Oligoclonal bands present in the CSF track only)
Serum
CSF
The Oligoclonal CSF with irregular spaced bands in the CSF only.
SWAPS

4. Type 3 “Systemic + Superimposed local synthesis
Monday, November 19, 2018
Type 3 “Systemic + Superimposed local synthesis
Oligoclonal pattern in CSF and serum but the bands differ in their isoelectric point’s &/or their intensities. Also known as the “greater than pattern” as there are more bands present in the CSF than the serum
Serum
The Greater than pattern. Identical bands in the CSF and Serum but extra bands at different pI’s (Isoelectric points) in the CSF.
CSF
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5. Monday, November 19, 2018
TYPE 4 “MIRROR” PATTERN (Oligoclonal bands in serum & CSF are at ccorresponding isoelectric point’s)
Control
Serum
SERUM
The mirror pattern with identical oligoclonal bands present in the CSF and serum.
CSF
CSF
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6. Monday, November 19, 2018
TYPE 5 MONOCLONAL RESPONSE (Bands are at corresponding isoelectric points and show the typical ladder pattern of a monoclonal signature)
Serum
The monoclonal response. Here the banding has crossed into the intrathecal space from the serum.
CSF
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7. Monday, November 19, 2018
TYPE 6 INTERMEDIATE (This pattern is less commonly seen. Follow-up studies have shown that some patients go on to develop an Oligoclonal pattern, others develop a typical “ladder” monoclonal pattern, while some remain with a single monoclonal band present in the CSF such as shown here).
Serum
CSF
I have included this slide because it shows only a single band. We have seen a number of samples like this. In one patient we were able to follow it up and was confirmed with a brain lymphoma.
This patient presented with some paralysis of unknown cause
X-rays did not reveal anything
Cat scan also failed to show anything
CSF oligoclonal bands was requested. Single monoclonal IgG band in CSF reported.
A repeat CSF collection for Oligoclonal bands was performed and findings remained the same.
On the basis of the CSF results an MRI was performed and showed numerous lesions throughout the brain.
A MRI guided fine needle biopsy was performed and histological diagnosis confirmed a lymphoma of the brain.
This pattern fails to fit any of the categories previously recognised.
At present it is not known whether a single monoclonal response in the CSF will convert to an oligoclonal response
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