Objective: The course of relapsing–remitting multiple sclerosis (RRMS) is highly variable and there is a lack of effective prognostic biomarkers. This study aimed to assess the potential prognostic value of the chemokines B lymphocyte chemoattractant molecule (CXCL13), eotaxin-1 (CCL11), and macrophage inflammatory protein 3-alpha (CCL20) in RRMS. Methods: Forty-two patients with MS were enrolled, along with 22 controls, 12 of the controls were idiopathic intracranial hypertension (IIH) patients, and 10 of the controls were other neurologic diseases (OND). Chemokine levels were measured using enzyme-linked immunosorbent assay (ELISA) in serum and cerebrospinal fluid (CSF) samples. Results: No significant differences were observed among the groups in serum levels of CXCL13, CCL11, and CCL20 (p = 0.509, p = 0.979, p = 0.169, respectively). CSF CXCL13 levels were significantly higher in the OND group (p = 0.016). A PATH analysis showed CSF CXCL13 was significantly associated with new T2 hyperintense lesions on brain magnetic resonance imaging (p < 0.001), and baseline serum CCL11 levels were associated with EDSS (p = 0.030), implying its potential role in indicating neurodegenerative processes and possible progression risk. Serum CCL20 correlated with EDSS (p = 0.002) and lesion burden (p < 0.001), reflecting disease severity. Conclusions: These findings suggest that CSF CXCL13 could serve as a useful biomarker for predicting active disease in RRMS, while follow-up serum CCL11 may assist in identifying progression. Although these chemokines are not specific to MS, higher levels may signal disease activity, severity, and transition to more progressive stages.

Background and purpose – High titers of anti-SARS-CoV-2 immunoglobulin G (IgG) have been reported in cerebrospinal fluid (CSF) samples of patients with COVID-19, but the data are limited. Our purpose is to report the clinical features and CSF findings of patients with neurologic symptoms in the pandemic era, and to discuss the origin and importance of anti-SARS-CoV-2 IgG in CSF. Methods – The data of 100 patients hospitalized in neurology inpatient clinics and tested for anti-SARS-CoV-2 IgG antibodies in CSF samples, between May 2021 and March 2022, were evaluated in a retrospective manner. Demographic features, presence of coronavirus disease 2019 (COVID-19) and/ or COVID-19 history, vaccination, vaccine type, and neurologic diagnoses were noted. CSF and serum anti-SARS-CoV-2 antibody ratio (AR) were assessed using a Euroimmun ELISA assay. CSF cytology, CSF protein level, oligoclonal band, IgG index, and albumin quotient (QAlb) were analyzed and compared between CSF AR positive and negative groups. Results – QAlb and CSF protein levels were higher in the CSF anti-SARS-CoV-2 AR-positive group compared with CSF anti-SARSCoV-2 AR-negative group (p<0.05). IgG index, CSF cytology, and oligoclonal band (OCB) types did not differ between the groups. Seventy-three percent of patients had OCB type-1. CSF anti-SARS-CoV-2 AR was correlated with serum anti-SARS-CoV-2 AR, Qalb, and CSF protein level, as well as COVID-19 and/or COVID-19 history and vaccination. Conclusion – Anti-SARS-CoV-2 antibodies in CSF seem to be related to a past immunization or a pre-existing cross reactive immunity and passive diffusion through a disrupted blood-brain-barrier, but not to an intrathecal antibody synthesis.

Background: High-resolution ultrasound is increasingly used as a complementary tool in carpal tunnel syndrome (CTS), but the value of median nerve cross-sectional area (CSA) for severity stratification remains uncertain. This study evaluated whether median nerve CSA measured at the pisiform level can distinguish severe from moderate CTS classified according to the Bland grading scale. Methods: This prospective cross-sectional study included 72 participants: moderate CTS (n = 34), severe CTS (n = 24), and healthy controls (n = 14). Nerve conduction studies, abductor pollicis brevis needle electromyography, and ultrasound examinations were performed on the same day. CSA was measured three times by a blinded examiner, and the mean value was used for analysis. Correlation, age-adjusted linear regression, and receiver operating characteristic curve analyses were performed. Results: Median nerve CSA increased progressively from controls to moderate and severe CTS groups (8.0 ± 1.1, 16.5 ± 4.6, and 19.8 ± 3.4 mm², respectively; p < 0.001), with significant pairwise differences. Intraobserver and interobserver reliability were excellent (ICC = 0.95 and 0.91, respectively). CSA correlated positively with distal motor and sensory latencies and inversely with compound muscle action potential and sensory nerve action potential amplitudes. CSA also showed a weak positive association with neurogenic motor unit action potentials. In age-adjusted regression analysis, distal motor latency remained independently associated with CSA (B = 0.873, p = 0.002). A CSA cut-off of 18.5 mm² distinguished severe from moderate CTS with an area under the curve (AUC) of 0.728, sensitivity of 66.67%, and specificity of 79.41%. Conclusions: Median nerve CSA measured at the pisiform level may provide useful adjunctive structural information for CTS severity assessment and may show moderate discriminatory performance for differentiating severe from moderate CTS. CSA should be interpreted in conjunction with clinical and electrodiagnostic findings rather than as a stand-alone severity marker.