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Re: spinal tap
Posted By CCF MD mdf on August 21, 1998 at 10:27:35:

In Reply to: spinal tap posted by Sherry on August 21, 1998 at 08:58:19:

I recently had an MRI of the brain done,with alot of bloodwork and a B12 urine
test. Some of my bloodwork came back abnormal and there was alot
of protein...187. By the way I,m 42/F.No urinary infection.I have alot
of pain in my back and sternum,and weakness in the legs.My question is
the neurologist wants to do a spinal tap and I was wondering what all
they can tell from this? He mentioned multiple myeloma as a possiblity,
Will this test show this? I have ask questions here before and I really
appreciate this forum! I cant find any info about it on the net.
                                    Thanks Sherry : )
I'm not sure how to interpret the data presented. The symptoms don't immediately suggest multiple myeloma, though they don't argue against it either. It's just not enough information from a clinical (history and physical exam) point of view.
Why an MRI of the brain was done for back and sternum pain is not clear. Perhaps the leg weakness made your doctor think something was wrong in the brain, but if he/she was thinking about myeloma, that's not something that usually affects brain. A simple x-ray of the spine sometimes shows myeloma (though that's not the only test needed).
In general, when I'm faced with a patient whose symptoms and signs I don't understand, if there is any reason to suspect inflammation involving brain or spinal cord, a spinal tap is reasonable. Although it's not the most comfortable procedure in the world, it's not the worst either. It's pretty safe, and can be done in the office without much equipment or labor.
Typically, I order cell counts, total protein, and glucose, and sometimes specific infectious disease tests (such as a VDRL). Any single result is usually not enough to make a diagnosis. Rather, the pattern of lab test results in combination with the clinical information and perhaps imaging studies, is what helps with a diagnosis.
Myeloma isn't routinely diagnosed by spinal tap. I'm not a hematologist, but my understanding is that diagnosis is made by serum (blood) and/or urine protein electrophoresis demonstrating what's called an M-spike. Also, plain films may demonstrate lesions in bone (could be cause of bone pain), and bone marrow biopsy (ouch, sorry).
Myeloma can cause neuropathy (damage to nerves) and can damage vertebrae in the spine, thus indirectly causing damage to nerve roots or the cord itself. For that reason, neurologists are reasonably familiar with the disease. But the diagnosis of myeloma should probably be in the hands of your general practitioner, internist, or a hematologist/oncologist.
Sorry about the rambling answer. I hope this helps. Remember, this forum doesn't substitute for medial advice. CCF MD mdf.

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