case_images: PMC11075753_01
case_images: Longitudinal progression of cerebrospinal fluid (CSF) Qalbumin and cell count in index patient: Longitudinal progression of CSF Qalbumin (left y axis) and cell count (right y axis, cells/mul) in index patient.
case_images: fneur-15-1372266-g001.jpg
case_images: PMC11075753_01_fneur-15-1372266-g001.jpg
case_images: fig1
case_images: Subsequent lumbar punctures performed after the first administration on the following day and also at the beginning of the new cycle after 6 months continued to show consistently elevated cell counts (Figure 1).
case_images: May-Grunwald-Giemsa stained cerebrospinal fluid (CSF) cell image: Visible are hypersegmented neutrophil granulocytes (), as well as occasional mononuclear cells ().
case_images: fneur-15-1372266-g002.jpg
case_images: PMC11075753_01_fneur-15-1372266-g002.jpg
case_images: fig2
case_images: CSF with excessively increased leukocytes (5,200/muL, 98% granulocytes), elevated albumin quotient (11.12) without intrathecal immunoglobulin synthesis (IgG/Q 6.8 [oligoclonal bands type IV]; IgA/Q 4.94, IgM/Q 3.63), a lactate concentration of 4.38 mmoL/L and a glucose concentration of 77 mg/dL. CSF granulocytes exhibited a hypersegmented nuclear pattern in cytology (Figure 2), indicative of an activation response. After 8 weeks, we performed a follow-up diagnostic lumbar puncture, which showed normalization of all parameters pathological in the previous analyses (Figures 2, 3).
case_images: Cytokine profile in the cerebrospinal fluid (CSF) before intrathecal triamcinolone administration, 1 day after administration, and during follow-up. The heat map displays the concentrations of the cytokines eotaxin-3, interferon-gamma (INF-gamma), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) in the cerebrospinal fluid (CSF) of patients #1, #2, #3, #4 at two or three different time points: before (1) and 1 day after intrathecal triamcinolone administration (2), as well as after 2 months for patient #1 (3) and 3 months for patient #2 (3).
case_images: fneur-15-1372266-g003.jpg
case_images: PMC11075753_01_fneur-15-1372266-g003.jpg
case_images: fig3
case_images: CSF of patient #1 after intrathecal triamcinolone administration, while no relevant changes were observed in the control patients. Conversely, no alterations were detected in the levels of interferon-gamma (INF-gamma) or eotaxin-3 (Figure 3). After 8 weeks, we performed a follow-up diagnostic lumbar puncture, which showed normalization of all parameters pathological in the previous analyses (Figures 2, 3).