LP result

[lsichitiu]

My neuro said I do not have MS since my LP is normal. He gave me a copy of my results on my way out the door.
I read the results at home and indeed, there are no O bands and IgG index is normal.

I have a question though. On my CSF results, i saw that I have the following :

RBC 256                  Normal : 0
Macrophages 3         Normal 0
Seg 14 %                 Normal 0-6 %
Protein 45                Normal <= 45

I wonder why my neuro said is all normal since this values are out of range, and what this could mean ? I understand I do not have MS , but I just think that these things might be a clue of what is going on with me.

If you can shed some light, I would appreciate it.

[Karen99]

Was your LP a "traumatic tap?"  That could explain the reason for RBC's in the CSF.  

The patient usually knows if the tap was "traumatic."  A nerve can be hit and it bleeds.  I had one of those early on (hit a nerve and made my leg jump) and had a result of some blood.  Never had any problems from it - not even a headache.

They were testing for meningitis at the time - MS was not on the table yet.  

My second LP showed a slight elevation in total protein and no O-Bands.  I'm in that small percentage of persons with MS with no O-Bands.

Did they do a culture?  (C&S?)

Why not give your neuro a call and ask why you have red blood cells in the CSF?  

[LisaJF]

Even in the absence of oligoclonal bands, elevation of the IgG index, IgG synthesis rate is indicative of CNS inflammation. Many MS patients have abnormal immunoreactivity that can be demonstrated by CSF analysis. Abnormalities include: elevated immunoreactivity, elevated immunoglobulin IgG levels, increased IgG index, increased IgG synthesis rate, and oligoclonal bands.

Even in the absence of 0-bands, increased IgG index or rate indicates CNS inflammatory disease.  MS is one of them.  Again, as COBOB said, 10% of the population have absence of 0-bands in their CSF.  

Yes, there is a multitude of MS mimics which I am sure your doctor has already initiated testing, ie: Lyme, SLE (Lupus), Sarcoidosis, APS (Hughes Syndrome), Vit B12 deficiency, Sjrogen Syndrome.  There are many diseases that can mimic MS, however, as time elapses and your doctor eliminates all of the MS mimics you're not left with much explanation of your symptoms, unless of course you're redefining a new disease. :)

I am not familiar with your posts, but you did have a MRI of brain and spine done?  I see that you had the VEP and SSEP performed.  Which again, MS patients can have a result of "normal" too.


Keep on truckin', keep on being your own best advocate, for only YOU know what is normal for yourself and when something is wrong.  Tests may scream "normalcy" where MD's look at it as if "nothing" is wrong, however, you know better. If you're not getting the answers you need via PCP or Neurologist, keep on shopping until you find one who takes the time to look at the entire picture of your symptoms and tests without disregarding you as the patient.  Anyone who determines quickly whether or not you have MS without taking the time to observe and tosses the idea of anything else without explanation, is a great big indicator that you need to move onward.  Get the answers and explanations YOU deserve.

Lisa

[Deb61]

Alex and Bob are correct about negative LPs and the possibility of having MS.  You can still have MS and a negative LP.  I know of several people with a diagnosis of MS and a negative LP.  However, you may not have MS, either, even if all symptoms point to it.  I thought I had lupus for many years because my symptoms pointed to that; however, I was later diagnosed with MS--something I would have never thought I had.  So, yes, it's possible you have something else.

The list of MS mimics is incredible:  autoimmune diseases, vascular diseases, spinal/neck issues, sacrcoidosis, and many, many more.  I found a pretty good web site that may help.

http://www.unitedspinal.org/msscene/2009/12/08/disorders-that-mimic-multiple-sclerosis/

[lsichitiu]

Thank you for your answer.

I do not know what to do at the moment. All my symptoms scream MS. But I was thinking that maybe these findings in my CSF , even if they point away from MS, they point at something else that mimics MS very well. Question is what?

Thanks for reading

[COBOB]

And even if you do not have O-Bands, about 40,000 people in the US with clinically definite MS don't have O-Bands.  

Bob (who was diagnosed with Zero unique O-bands in his CSF.)

[lsichitiu]

Thank you for taking the time to answer me.

I hope you feel better!

[HVAC]

In MS they are looking for o-bands in the CSF and not the Blood and the IgG index. This show inflammation in the CSF only. LPs do not rule MS in or out they are a tool. Many with MS have no o-bands or normal LPs. There may be something else going on but Neurologists are only interested in MS. I do not know if that helps. Mine was going to LPs every six months until he found o-bands. Luckily I had lots the first LP.


Sorry this is frustrating.

Alex