Cerebrospinal fluid oligoclonal IgG bands in patients with spinal arteriovenous malformation and structural central nervous system lesions

Objective: To investigate the incidence and characteristics of patients wit h structural central nervous system (CNS) lesions and cerebrospinal fluid o ligoclonal IgG bands. Design: A retrospective study. Method: The medical records of patients with cerebrospinal fluid oligoclona l IgG bands were evaluated for the presence of structural CNS lesions, thei r location and cause, and for clinical characteristics. Setting: Cerebrospinal fluid oligoclonal IgG bands were examined in the Neu roimmunology Laboratory, Hadassah University Hospital, Jerusalem, Israel. Patients: Two hundred seventy of 570 patients with positive cerebrospinal f luid oligoclonal IgG bands were available for analysis. Twenty patients had structural CNS lesions. Results: Twenty (7.5%) of the 270 patients had structural CNS lesions: 3 pa tients had spinal arteriovenous mal-formation; 5 patients had tumors; 9 pat ients had compressive cervical myelopathy. Traumatic leukomalacia, Arnold-C hiari malformation type 1, and CNS hemosiderosis were present in 1 patient each. In 2 patients (1 patient with recurrent meningioma and 1 patient with posttraumatic encephalomalacia) the presence of a structural CNS lesion wa s followed by the development of multiple sclerosis. In all 3 patients with spinal arteriovenous malformation, oligoclonal IgG identification prolonge d the time to diagnosis and therapy, which varied from a few weeks to 3 yea rs. Conclusions: Structural CNS lesions, responsible for the neurological disor der, were present in 20 patients (7.5%) with cerebrospinal fluid oligoclona l IgG bands. The mechanism underlying oligoclonal IgG presence in spinal ar teriovenous malformation and the coexistence of multiple sclerosis and stru ctural CNS lesions is unknown, but may be related to recurrent tissue damag e with repeated presentation of CNS antigens to the immune system.