Aa
clinical findings confirming multiple sclerosis
a 47 yr old male presenting with clinical findings of CSF Proteins- 173.4mg / dl,
CSF glucose- 56mg/ ml, CSF cell count- 56 cell/ cu.mm, RBC count- 20 cells/ cu. mm, cryptococcus- negative, Toxoplasma IgG, CSF- H14.84 IU/ ML. and is positive for antimycobacterial antibody and mycobacterial immune complex of IgG type by ELISA, with cervical spine leisions
wanted to find out wheather its MS? / TRANSVERSE MYELITIS? / TB- spine ? / TBM?
CSF glucose- 56mg/ ml, CSF cell count- 56 cell/ cu.mm, RBC count- 20 cells/ cu. mm, cryptococcus- negative, Toxoplasma IgG, CSF- H14.84 IU/ ML. and is positive for antimycobacterial antibody and mycobacterial immune complex of IgG type by ELISA, with cervical spine leisions
wanted to find out wheather its MS? / TRANSVERSE MYELITIS? / TB- spine ? / TBM?
Hi, Welcome to the forum. I am one of those members Momzilla and SL were hoping would pop in here. I am a retired/disabled physician with MS, but I was not a neuro nor an Infectious Disease specialist. I could look all of this up, but my energy is very limited lately and I'm gonna wing it.
I see that your title states clinically confirmed MS. But your post deals only with some of the CSF findings so those are what I will deal with. Your CSF is not suggestive of MS, but you haven't given us the data that we would look for in MS. I see no mention of Oligoclonal bands nor of the IgG Index.
The total protein here is sky-high, not a finding in MS, where it would be expected to be normal or mildly high. Yours is in the range of meningitis and the type of meningitis that can get the CSF protein the highest is Tuberculous Meningitis. So my thoughts had already gone there by the time you mentioned "mycobacteria" (For everyone "Mycobacteria" is the scientific category that TB falls into). I don't know the clinical significance of the "Mycobacterium Immune Complex", but if I had to take a guess, it is now one of the things they look for in TB meningitis. Ditto with the Antimycobacterium antibody. I'm sure a TB culture is pending, but may take many weeks. The buggers grow slowly.
The CSF Glucose is normal to slightly low, consistent with an infection.
The white cell count is elevated, but not drastically. It would be nice to know what kind of cells they are, but I would guess lymphocytes. The few reds cells mean nothing.
There is also evidence of infection (maybe prior) to Toxoplasmosis which can also invade the Central Nervous System as an opportunistic infection. At this point I am worrying about an immune deficiency, allowing multiple opportunistic infections.
Your questions was what might this indicate. There is nothing reported to tell us to think about MS, but there is no reason someone with MS can't also have an odd form of meningitis. However, meningitis is a mimic of MS, especially the unusual and slowly developing forms and it is one of the reasons for doing the LP. We always try to explain a patient's problems with one answer, but we are sometimes left with two or three.
Tranverse Myelitis - Ditto the above paragraph.
TB of the Spine - this indicates TB in the vertebrae (Potts's Disease, I think). No, I do not believe that this would cause these CSF findings. Maybe, if the infection was right up against the CSF sac it might cause some non-specific inflammation, but not these findings.
TB Meningitis - The CSF (to my 25 year old memory - last time I dealt with it) fits this.
Toxoplasma meningitis - I don't know what they look for to diagnose it - out of my league.
Could TBM mimic MS clinically (means from the patients history and physical)? I would think so.
That is the most I could wring out of those findings. I hope this helped.
Quix
I see that your title states clinically confirmed MS. But your post deals only with some of the CSF findings so those are what I will deal with. Your CSF is not suggestive of MS, but you haven't given us the data that we would look for in MS. I see no mention of Oligoclonal bands nor of the IgG Index.
The total protein here is sky-high, not a finding in MS, where it would be expected to be normal or mildly high. Yours is in the range of meningitis and the type of meningitis that can get the CSF protein the highest is Tuberculous Meningitis. So my thoughts had already gone there by the time you mentioned "mycobacteria" (For everyone "Mycobacteria" is the scientific category that TB falls into). I don't know the clinical significance of the "Mycobacterium Immune Complex", but if I had to take a guess, it is now one of the things they look for in TB meningitis. Ditto with the Antimycobacterium antibody. I'm sure a TB culture is pending, but may take many weeks. The buggers grow slowly.
The CSF Glucose is normal to slightly low, consistent with an infection.
The white cell count is elevated, but not drastically. It would be nice to know what kind of cells they are, but I would guess lymphocytes. The few reds cells mean nothing.
There is also evidence of infection (maybe prior) to Toxoplasmosis which can also invade the Central Nervous System as an opportunistic infection. At this point I am worrying about an immune deficiency, allowing multiple opportunistic infections.
Your questions was what might this indicate. There is nothing reported to tell us to think about MS, but there is no reason someone with MS can't also have an odd form of meningitis. However, meningitis is a mimic of MS, especially the unusual and slowly developing forms and it is one of the reasons for doing the LP. We always try to explain a patient's problems with one answer, but we are sometimes left with two or three.
Tranverse Myelitis - Ditto the above paragraph.
TB of the Spine - this indicates TB in the vertebrae (Potts's Disease, I think). No, I do not believe that this would cause these CSF findings. Maybe, if the infection was right up against the CSF sac it might cause some non-specific inflammation, but not these findings.
TB Meningitis - The CSF (to my 25 year old memory - last time I dealt with it) fits this.
Toxoplasma meningitis - I don't know what they look for to diagnose it - out of my league.
Could TBM mimic MS clinically (means from the patients history and physical)? I would think so.
That is the most I could wring out of those findings. I hope this helped.
Quix
Hi!
I'm glad you finally found it. Hope you got a good sleep. Talk to you soon!
Start your own thread, and tell us about yourself!
Zilla*
I'm glad you finally found it. Hope you got a good sleep. Talk to you soon!
Start your own thread, and tell us about yourself!
Zilla*
hi momvilla thank you so much for hanging in there with me !!!! you were the first time i responded to this forum and i went back the next day and been looking for the post..... god it has about grove me to the nut house!!!! but thank god i found it. i do have lots of concerns, questons. i have to go to bed now its 430 am I work eves and have been on line sence 230 am . thank you!!! and sllowe, for responding. i will surely get back to ya all asap.
thanks again Denise
thanks again Denise
Welcome!
I bumped up some informative posts regarding MRIs and MS diagnosis, written by Quixotic1, who is a retired physician, although she always includes the disclaimer that she was not a neurologist. She has done LOTS of research for us, and with her own vast medical knowledge, has come up with brilliant info regarding these issues.
Please read them and post any questions on a new thread if you wish.
Feel well!
Zilla*
I bumped up some informative posts regarding MRIs and MS diagnosis, written by Quixotic1, who is a retired physician, although she always includes the disclaimer that she was not a neurologist. She has done LOTS of research for us, and with her own vast medical knowledge, has come up with brilliant info regarding these issues.
Please read them and post any questions on a new thread if you wish.
Feel well!
Zilla*
Hi APR,
Welcome APR. We'd like to help, but have a few question. It is hard to share your personal information, so if you choose not too, that's fine too.
Is this a report? Does it include what you've listed in the subject line, that clinical findings confirm MS? Are you concerned that it's correct, incorrect?
Just need a little more information. Otherwise, we may be limited in helping you out with your specific concerns.
If you want, share what you can, and know we will support you the best we can.
-----------
Denise:
Welcome to you too, if you don't mind, please repost your comments, as a separate post, I think you'll find you'll get more responses.
We have a few members under the weather, and others tending to family, so we are a bit delayed, but hang in there, and feel free to bump up your post if necessary. Thank you for joining in. . .
Be well,
SL
Be well,
SL
Welcome APR. We'd like to help, but have a few question. It is hard to share your personal information, so if you choose not too, that's fine too.
Is this a report? Does it include what you've listed in the subject line, that clinical findings confirm MS? Are you concerned that it's correct, incorrect?
Just need a little more information. Otherwise, we may be limited in helping you out with your specific concerns.
If you want, share what you can, and know we will support you the best we can.
-----------
Denise:
Welcome to you too, if you don't mind, please repost your comments, as a separate post, I think you'll find you'll get more responses.
We have a few members under the weather, and others tending to family, so we are a bit delayed, but hang in there, and feel free to bump up your post if necessary. Thank you for joining in. . .
Be well,
SL
Be well,
SL
hi i also have the high protein level, it was found when Docs tested me for the blood clotting d-dimer test. i googled it and yes there is many things it can be. iam new here and have been reading this forum for some time..... trying to find answers to my problems...
thanks Denise61
thanks Denise61
Welcome! Have you postedbefore? Sorry if I don't recognize the name.
I'm not sure yet, according to the fluid readings, but tell us your symptoms. The protein level is quite high, I know, but could indicate a lot of different disease processes. The others,I'm not sure.
The thing which is the HUGE red flag, of course, is the presence of cervical spine lesions. Again, what symptoms are you having? What does the doctor say?
I'm sorry you are having such trouble. Please let us know what's going on. We can help.
Take care!
Zilla*
I'm not sure yet, according to the fluid readings, but tell us your symptoms. The protein level is quite high, I know, but could indicate a lot of different disease processes. The others,I'm not sure.
The thing which is the HUGE red flag, of course, is the presence of cervical spine lesions. Again, what symptoms are you having? What does the doctor say?
I'm sorry you are having such trouble. Please let us know what's going on. We can help.
Take care!
Zilla*
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