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Arthritis (Expert Forum)
Spinal tap . . . questions?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Spinal tap . . . questions?
by gramsto4, Jul 31, 2006 12:00AM
I would just like to ask you a couple of questions . . . the results of my spinal tap are as follows:
There are zero or one additional oligoclonal bands present in the CSF that are not apparent in the serum. The presense of less than two additional bands in the CSF than the serum is considered negative. A small percentage of patients with clinically definite MS are negative for oligoclonal bands. The immunofixation/Isoelectricfocusing methods show 0 IgG bands in the CSF that are not visible in the serum.
IgG CFS 1.5 Range 0.0 - 6.0 mg/dL
Serum IgG 752 Flag L 768-1632 mg/dL
OLIGCL BND NEG NEG
CSF Myelin 1.82 0.07-4.10 ng/mL
ALB INDEX 3.9 0.0 - 9.0 ratio
IgG INDEX 0.51 0.28-0.66
IgG SYNTH 0 0.0 - 8.0 mg/d
IgG/ALB 0.08 Flag L 0.09-0.25 ratio
ALBUMN CSF 18 0-35 mg/dl
Anti-Neuronal Cell Ab, CSF < 0.5 0-1.0 UNITS
This is all (I hope) good news. I haven't heard anything from my doctor (so I am assuming so). The questions are: With 3 positive ANA's, CRP's, and one elevated sed rate, an elevated serum creatinine x's one, and several elevated BUN's and Creatinines U/A's. An EEG and MRI that had "normal" abnormalities. . . both in the left frontal lobe and a CT scan that was okay. (all tests but BUN's/Creatinines in past year). Can you possibly recommend anywhere to go from here. Rheumatologist here in town refused to accept me as patient (because UCTD is not an active autoimmune disease) and there are only two rheumy's for a town of over 100,000 so she's too busy.
I continue with the follwing symptoms:
Extreme fatigue, fevers, 99.4 - 101.0 (average), headaches and eye pain, swollen lymph nodes (occas), mouth sores, joint and muscle pain, photosensitivity (big time), hives, cognitive problems, (have had 3 stroke-type episodes??) Anyway, I'm going to be moving and would appreciate any input that would be helpful for me approaching a new physician. Thank you.
There are zero or one additional oligoclonal bands present in the CSF that are not apparent in the serum. The presense of less than two additional bands in the CSF than the serum is considered negative. A small percentage of patients with clinically definite MS are negative for oligoclonal bands. The immunofixation/Isoelectricfocusing methods show 0 IgG bands in the CSF that are not visible in the serum.
IgG CFS 1.5 Range 0.0 - 6.0 mg/dL
Serum IgG 752 Flag L 768-1632 mg/dL
OLIGCL BND NEG NEG
CSF Myelin 1.82 0.07-4.10 ng/mL
ALB INDEX 3.9 0.0 - 9.0 ratio
IgG INDEX 0.51 0.28-0.66
IgG SYNTH 0 0.0 - 8.0 mg/d
IgG/ALB 0.08 Flag L 0.09-0.25 ratio
ALBUMN CSF 18 0-35 mg/dl
Anti-Neuronal Cell Ab, CSF < 0.5 0-1.0 UNITS
This is all (I hope) good news. I haven't heard anything from my doctor (so I am assuming so). The questions are: With 3 positive ANA's, CRP's, and one elevated sed rate, an elevated serum creatinine x's one, and several elevated BUN's and Creatinines U/A's. An EEG and MRI that had "normal" abnormalities. . . both in the left frontal lobe and a CT scan that was okay. (all tests but BUN's/Creatinines in past year). Can you possibly recommend anywhere to go from here. Rheumatologist here in town refused to accept me as patient (because UCTD is not an active autoimmune disease) and there are only two rheumy's for a town of over 100,000 so she's too busy.
I continue with the follwing symptoms:
Extreme fatigue, fevers, 99.4 - 101.0 (average), headaches and eye pain, swollen lymph nodes (occas), mouth sores, joint and muscle pain, photosensitivity (big time), hives, cognitive problems, (have had 3 stroke-type episodes??) Anyway, I'm going to be moving and would appreciate any input that would be helpful for me approaching a new physician. Thank you.
Doctor's Answer
by Kevin Pho, MD, Aug 01, 2006 12:00AM
, Aug 01, 2006 12:00AM
You have had a comprehensive evaluation for your symptoms. There problably isn't any further testing I can recommend. A consideration would be the biopsy the lymph nodes if they persist to be swollen. Obtaining further analysis of the auto-antibodies may also help.
Depending on your insurance, you may need a referral from your new PCP to see a rheumatologist. Given that you have been through such comprehensive testing, I would consider a rheumatologist at a major academic medical center. The cognitive problems can be evaluated by a neurologist to ensure that strokes or TIAs aren't occurring.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Depending on your insurance, you may need a referral from your new PCP to see a rheumatologist. Given that you have been through such comprehensive testing, I would consider a rheumatologist at a major academic medical center. The cognitive problems can be evaluated by a neurologist to ensure that strokes or TIAs aren't occurring.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
I don't really have the mouth ulcer's though, rather I've had autoimmune hearing loss, reiter's syndrome like symptoms, two bout's of aspectic meningitis...elevated Sed rates and high reactive protein results.
Colchine which is an anti gout medication (sp) was prescribed for me and gave me relief from the frontal headaches, but I also take Indicin as well as a lot of other drugs for other things...