CSF question , please help

[vanhawk48]

Hi to all
I have my CSF tested couple of years ago  .

MYEL  BASIC PROTEIN           2.60  f                                                                       0.07 - 4.10 ng /ml
  
What  catches my  eye  is the  information under  quote "  -  Test information : Myelin   Basic Protein
                                                This test  uses  a kit designated by manufacturer  as for research use , not for
                                                clinical  use . The performance characteristics of this test were validated by
                                                ARUP  Laboratories  Inc. The US  Food and Drug Administration  ( FDA) has
                                                not  approved this test  . The results are not intended to be used as the sole
                                                means for clinical diagnosis or patient management decisions. ARUP is autho-
                                                rized  under Clinical Laboratory Improvement Amendments (CLIA) and by all
                                                states  to perform high  complexity testing ."-

Tubes Rec                                   4
Total  volume                              11.0
Color                                  Colorless
Appearance                         Clear      
CSF                                    CSF
RBC  Cell Ct                          0
NUC  Cell Ct                          1
CSF Polys                             2
CSF Lymphs                        95  H    
CSF Macropha                       3  L

  Differential based on 62 cells  counted  on double concentrated cytospin smear

CSF Glucose     63                                                                   40 - 70   MG/ DL
CSF Protein       43                                                                   15 - 45   MG/DL

MS Panel
IGG Serum         885                                                                   768 - 1632     mg /dl
IGG CSF                2.0                                                                 0.0 -    6.0    mg/dl
Albumin Serum   4470                                                                 3500 - 5200    mg/dl
Albumin CSF         24                                                                       0 - 35       mg/dl
Albumin Inde         5.4                                                                    0.0 - 9.0      ratio
Synthesis  Ra       0.0                                                                    0.0 - 8.0      mg/dl
IGG Index             0.42                                                                  0.28 - 0.66   ratio
IGG Albumin         0.08 L                                                               0.09 - 0.25   ratio
Oligoclonal band    Neg                                                      

Please  tell me  if  the  H  and  low  numbers  should be  addressed  and  also  if the   2.60 f  Myelin Basic Protein is the  number for oligoclonal bands ?
Vanda

[Lulu54]

Hi Vanda,
I am absolutely no good at reading lab  results, but if you look at that very last line  it reads the no o-bands were found.  ... "oligoclonal band NEG"    negative for bands in the four vials of csf taken.  

The L and H numbers are so close to normal range that I don't believe your doctor will want to do anything about them.  Agian, that's just mhy guess.

Overall it looks like your CSF results are good.  Have you seen your neuro yet to discuss them?

no expert,
Lulu

[Lulu54]

oops, I just reread and see that these results are two years old.  did your neuro interpret these results for you back then?

[vanhawk48]

Hi Lulu
Yes  he did but he  was  not  a  great  communicator and  he also  mentioned something about  different  interpretation by different  standard , but at that  time  I was  scared to death  and  not ready  to face  any of this .
Currently I have a new neuro , because  my  first one  left  town .
The new  one  listen  more and  talk more  and  I feel  like  I can communicate better .
Hope to know  little more  soon .
Thank you very much for your input .
Vanda

[Quixotic1]

So good to see you!

Your CSF results are all normal with the exception of the Myelin Basic Protein, MBP.   It was thought a few years ago that the MBP might be a marker for MS, but it has been shown that it can be elevated during many different disease processes, like viral syndromes.  So, it has not shown to be of specific use except as a general indicator that there is myelin metabolism going on in the central nervous system - meaning myelin breakdown and repair, where lots of MBP is being made and is floating around in the CSF.  So, it's the kind of info that would support a Dx of MS, but not on it's own.

The High Value is for the cell "percentages."  Your actual cell count was 1 WBC seen per tiny drop of fluid.  That is well within normal range.  When they spun the big sample down to collect all the cells they could, they then counted enough cells to see what cells were there.  They were able to count 62 cells and 95 % of them were lymphocytes, 2 % were macrophages (monocytes) and 3% were lymphocytes.  (The sum of 95 + 2 +3 = 100 percent).  In general, you would expect to see as a more equal distribution of the differnt kinds of cells.

This would support a "theory" that at some time in the recent past before this LP, you had had an infection, likely a viral infection in your central nervous system.  During a viral meningitis, for example, the CSF will show an elevated WBC count and most of the cells will be lymphocytes.  (During a bacterial meningitis, like HIB or meningococcal, there will be usually greater than 95% neutrophils.)  Going along with this theory is the elvated Myelin Basic Protein which will often be elevated during a viral infection of the brain and meninges.  (The meninges are the fibrous linings around the brain and cord.)

In general, neutrophils fight bacteria and lymphocytes fight viruses (and other things).  Macrophages (macro=large, phage=eaters) are the debris cleanup crew.

In MS you would expect a normal cell count.

So the High value suggests a little to us.  The Low value is meaningless.

The only parts of the MS CSF panel that mean anything are the IgG Index (which is normal) and the O-Band number.  The rest of those things have to be obtained ONLY in order to determine (calculate) the IgG Index.  They are not usually looked at individually.

A lot of talk to say that your results, taken by themselves, sort of suggest that you were just past a viral infection in your CNS.  They do not PROVE that, however.  No, there is nothing to worry about here or to point specifically toward MS.

Does that help?

Quix

[vanhawk48]

Wow  ,  nobody ever  explained  it  to me this  way . Thank you so very much .
I  understand  this is just  another  test which may be helpful in Dx .
Yes , I  do  have  clinical  history  consistent  with  MS  , as  stated  by  MS  neuro , and  also  MRI  with  multiple  lesions .
I have  been  Dx  in  Sept 2007 and  than  in  May of 2008  I have  been  told  that  since  the load of lesions  have not  change , this is probably not MS .
Since  than  I have changed  my  neuro ( the first one left  the town ), and my new MRI showed  additional  lesions  in my  brain , one lesion  in  cervical spine and  one in thoracic .
I am going  to see the neuro  on  this  coming  Wednesday
I will  post  the updates .
Thank  you  Quix  for this  explanation  of my  results .
Vanda