Moffitt Report Pearls 8/3: Elevated CSF Protein

Oligoclonal what? (Protein-related terms you often hear when talking about CSF)

  • Albuminocytologic dissociation: elevation in CSF protein without an elevation in white blood cells. This is thought to be inflammation of the nerve roots. Most CNS protein is usually albumin. Classic textbook association is with AIDP (a.k.a Guillain-Barre).
  • Oligoclonal bands: immunoglobulins are usually excluded from CSF. “Oligoclonal bands” refers to immunoglobulins in the CSF that exhibit bands on protein electrophoresis. This indicates inflammation of the CNS. Textbook association is with multiple sclerosis and can be considered as part of the diagnosis, but nonspecific and other conditions can cause this.

Elevated protein in the CSF

  • Usual protein concentration is 15-50 mg/dL (UCSF lab)
  • Differential (adapted from this excellent online book from Darmouth:
    • Malignancy
      • Primary CNS tumor vs mets
      • Paraneoplastic syndromes (SCLC, seminoma and other testicular tumors are the common culprits of paraneoplastic encephalitis)
    • Inflammatory conditions
      • Peripheral neuropathies (e.g. AIDP)
      • Lupus cerebritis, neurosarcoid, vasculitis and other rheumatologic conditions
    • Infection (long list)
    • Endo/metabolic
      • Diabetes mellitus
      • Hypothyroidism
    • Other
      • Lab error
      • Degenerative disease (occasional and only minimal elevation)
      • Obstruction of CSF flow
    • Serum protein in the CSF (accompanying CNS hemorrhage or a traumatic tap: subtract approx. 1mg/dL protein for every 1000 RBCs)
    • Stroke (usually not greater than 100mg/dL)

Evernote link:


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