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. 2025 Feb 15;272(3):207.
doi: 10.1007/s00415-025-12947-y.

Multiple sclerosis diagnosis and its differential diagnosis in patients presenting with type four 'mirror pattern' CSF oligoclonal bands

Damiano Marastoni #  1 , Monica Sicchieri #  1 , Francesca B Pizzini  2 , Arianna Scartezzini  1 , Federica Virla  1 , Ermanna Turano  1 , Daniela Anni  1 , Maddalena Bertolazzo  1 , Stefano Ziccardi  1 , Valentina Camera  1 , Agnese Tamanti  1 , Maddalena Marini  3 , Giuseppe Lippi  3 , Bruno Bonetti  4 , Andrew J Solomon  5 , Massimiliano Calabrese  6
Affiliations

Multiple sclerosis diagnosis and its differential diagnosis in patients presenting with type four 'mirror pattern' CSF oligoclonal bands

Damiano Marastoni et al. J Neurol. .

Abstract

Background: Presence of oligoclonal bands (OCBs) restricted to cerebrospinal fluid (CSF) characterizes most patients with multiple sclerosis (MS). Few data are available on the frequency of MS diagnosis and the main alternative diagnoses in patients with an initial central nervous system (CNS) demyelinating event and CSF IV pattern, the so-called 'mirror pattern'.

Methods: Seventy-six patients presenting with OCBs pattern IV after a clinical attack suggestive of CNS demyelinating event were included in the study. Diagnostic work-up, including blood, CSF, and paraclinical examinations, and 2 years of clinical and radiological follow-up were evaluated.

Results: Pattern IV occurred in 15.1% of patients. Twenty-five patients (32.8%) received a diagnosis of MS, thirty-two (42.1%) an alternative diagnosis, and nineteen (25%) remained without definite diagnosis. Most frequent alternative diagnosis was encephalopathy with atypical MRI lesions of probable vascular origin (19.7%). MS was significantly more common in patients with type IV OCB pattern (25 of 76) than in a group of patients presenting with type I OCB pattern (32 of 168, p = 0.017).

Conclusion: The diagnosis of MS is common in patients who present with OCBs pattern IV. However, other CNS disorders, particularly vascular encephalopathy, should be carefully considered.

Keywords: Cerebrospinal fluid; Differential diagnosis; Mirror pattern; Multiple sclerosis diagnosis; Oligoclonal bands.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: The local Ethics Committee approved the study, and all patients signed an informed consent (MSBioB, 2413CESC).

Figures

Fig. 1
Fig. 1
Study plan. Patients’ cohort according to the diagnosis received at initial diagnostic work-up and after 2-year follow-up. RRMS relapsing–remitting multiple sclerosis
Fig. 2
Fig. 2
Atypical MRI lesions in patients with an alternative diagnosis. a Bilateral small juxtacortical frontal T2-hyperintese lesions, the larger one within the right inferior frontal gyrus (5 mm longitudinal axis) in a patient with anti-MOG encephalopathy. b Bilateral small juxtacortical, deep and periventricular frontal parietal and T2-hyperintese lesions, partially confluent within the posterior white matter in a patient with vascular encephalopathy
See this image and copyright information in PMC

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