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CSF Lab Results
I just got my lab results back and would really like some help interpreting them:
IgG Serum Quant 1030
IgG CSF 1.6
Albumin, Serum (Neph) 1990
Albumin Index 3.5
CSF IgG Synthesis Ra <0.0
IgG Index 0.44
CSF IgG/Albumin Rati 0.11
Oligoclonal Band Positive--4 bands
Myelin Basic Protein 0.45
About 2 months ago I started having vision problems in my left eye. It became sore and a brown cloud was in the bottom 1/4. I was initially diagnosed with a swollen eye due to allergies and prescribed over the counter drops. Vision loss continued over several weeks until my entire eye was blurry and still is. I was referred to a optic neurologist who ordered and MRI. The MRI showed no lesions and no optic neuritis--just evidence of "periorbital edema" "anterior to the globes". "Both optic nerves were healthy". I also became very ill with a sinus infection and flu like symptoms. I also had stiffness in my left should and the left back side of my neck. I was on anti-biotics for the sinus infection for a couple weeks and have been on Cellebrex for over a month. The Cellebrex helps control the swelling of my eye for the most part, but my vision is still blurry.
The optic neurologist does not think I have MS. He thinks maybe the 0-bands could be related to having West Nile Virus in the past. My labs showed that I had had West Nile Virus (WNV IgG 2.44/ WNV IgM 0.06). I am concerned about the O-bands and what the CSF results mean. If not MS then could they mean meningitis or some other viral infection? I would really appreciate any help in interpreting these results. Thanks--Sunny51
IgG Serum Quant 1030
IgG CSF 1.6
Albumin, Serum (Neph) 1990
Albumin Index 3.5
CSF IgG Synthesis Ra <0.0
IgG Index 0.44
CSF IgG/Albumin Rati 0.11
Oligoclonal Band Positive--4 bands
Myelin Basic Protein 0.45
About 2 months ago I started having vision problems in my left eye. It became sore and a brown cloud was in the bottom 1/4. I was initially diagnosed with a swollen eye due to allergies and prescribed over the counter drops. Vision loss continued over several weeks until my entire eye was blurry and still is. I was referred to a optic neurologist who ordered and MRI. The MRI showed no lesions and no optic neuritis--just evidence of "periorbital edema" "anterior to the globes". "Both optic nerves were healthy". I also became very ill with a sinus infection and flu like symptoms. I also had stiffness in my left should and the left back side of my neck. I was on anti-biotics for the sinus infection for a couple weeks and have been on Cellebrex for over a month. The Cellebrex helps control the swelling of my eye for the most part, but my vision is still blurry.
The optic neurologist does not think I have MS. He thinks maybe the 0-bands could be related to having West Nile Virus in the past. My labs showed that I had had West Nile Virus (WNV IgG 2.44/ WNV IgM 0.06). I am concerned about the O-bands and what the CSF results mean. If not MS then could they mean meningitis or some other viral infection? I would really appreciate any help in interpreting these results. Thanks--Sunny51
Thank you for your great answer. The O-bands were unique to the CSF. My doctor thinks my eye is due to ischemic optic neuropathy rather than optic neuritis because the impaired vision seems to be permanent. After 21/2 months the inflamation is finally subsiding and my energy has returned, but the blurred vision remains. Although there havn't been any other indicators or symptoms, he hasn't ruled out that the possibility that I have MS and will do another MRI in a year or so. I have an appointment to get a second opinion.
This forum is full of really kind supportive people.--Sunny
This forum is full of really kind supportive people.--Sunny
I cannot help at all with the results, sorry about that. Second opinions never hurt!
However, as for diagnostic tests - this one is a BEAR. I just wanted to give you a high five for surviving. I went back for the blood patch, just to get the full experience - HA!
There was a post that I found helpful when I first joined. I am going to try and find it.
However, as for diagnostic tests - this one is a BEAR. I just wanted to give you a high five for surviving. I went back for the blood patch, just to get the full experience - HA!
There was a post that I found helpful when I first joined. I am going to try and find it.
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The first 5 things and the 7th are used to calculate the important value, the IgG Index. Yours is (I think) normal, but it is not given much credence by working neuros. I think the cutoff is about 0.67 to be elevated, but I'm not sure. The IgG Index is a calculated value (rather than directly measured) indication of the amount of antibody synthesis that is occurring in CSF as compared to the rest of the body.
The other important value is the 4 Oligoclonal Bands. What this report does not tell us is whether the 4 O-Bands in the CSF are UNIQUE to the CSF or if any of those same bands also appear in the serum. Do you have that report? Did they draw blood the same day as the spinal tap?
I do not know if the West Nile Virus can cause lingering and multiple O-Bands in the CSF.
Since you still have some WNV IgM lingering in the spinal fluid, it might be that your bout with the virus was recent (within the last few months). The IgM is the first antibody made in respnse to an infection and it fades out after a couple months and as the IgG rises and becomes the lifelong antibody.
Any infection of the central nervous system can certainly mimic MS.
I'm concerned by the loss in vision as I am sure (hope) the neuro-ophthalmologist is. Could this also be due to the virus? However, with a physical exam and an MRI he does not have enough information to declare that your optic nerves are healthy. In optic neuritis the physical exam is normal in 64% of people. The MRI often misses small lesions on the optic nerve.
Since your vision continues to be affected there are further tests that could be done to assess the health of the otpic nerves. The most important of these is a Visual Evoked Response to see if the optic nerve is carrying the visual signal to the brain as fast as normal. The second is not standardized, but is quick and painless and that is the OCT. This test measures the thickness of the outermost Retinal Nerve Fiber Layer on the optic disc. It can show thinning which is too small for the physical exam to show.
The other result is the Myelin basic Protein. This is a protein that is released in larger amounts when there has been damage to nerves in the CNS, such as MS, but also in a lot of other disorders, expecially infections. So WNV could be a culprit there. Also I don't know if that level is elevated.
The WNV really does complicate the picture, expecially since you don't know exactly when you had it. I think you are going to need time to help sort this out, but in the meantime someone really needs to answer why the loss in vision. A second opinion, perhaps?
I'm afraid I have been less than helpful. I hope you stay around and others chime in.
Quix, MD