does this seem to fit MS

Question

CSF CELL COUNT & DIFFERENTIAL		8/4/2008
CSF - APPEAR		CLEAR
CSF - WBC		0
CSF - RBC		1023
CSF - DIFF		DIFF NOT INDICATED
CSF CHEMISTRIES		
GLU #	40 - 70	69
LACTIC	0.0 - 2.8	2.1
LDH	>=0	10
PROTEIN	15.0 - 45.0	25.8
CSF CULTURE		MODERATE RED BLOOD CELLS / NO ORGANISMS SEEN
MULTIPLE SCLEROSIS EVAL DATE RECEIVED 8-5-08  DATE REPORTED 8-9-08		
IGG SERUM	768 - 1632	1060
IGG CSF	0.0 - 6.0	3.0
ALBUMIN SERUM	3500 - 5200	4160
ALBUMIN CSF	0 - 35	17
ALBUMIN INDEX	0.0 - 9.0	4.1
CFS IGG SYNTHESIS RATE	0.0 - 8.0	1.4
IGG INDEX	0.28 - 0.66	0.69 H
CSF IGG/ALBUMIN RATIO	0.09 - 0.25	0.18
CSF OLIGOCLONAL BANDS	NEG	POSITIVE A
MYELIN BASIC PROTEIN	0.07 - 4.10	1.38
INTERPRETATION/SPEC CHEM		7
Increased concentrations of IgG in the CSF is an important indicator for MS but may also be associated with increased local production of IgG, or both.  Increased IgG production is demonstrated by an increased CSF IgG/Albumin ratio, IgG index and IgG synthesis rate.  As compared to the serum, isoelectric focusing/immunofixation reveals     7   IgG bands that are unique to the CSF.  This is consistant with intrathecal synthesis of immunoglobulin and is considered to be a positive result for the oligoclonal bands.  Oligoclonal bands are present in over 90% of patients with MS but may also be present in CSF from patients with viral or bacterial meningeoencephalitis, SSPE, neurosyphilis, Guillian-Barre syndrome, and meningeal carcinomatosis.		
please help me

DrSharma · Accepted Answer

Hi there. These CSF findings need to be correlated with history, clinical examination and other ancillary investigations. Your doctor will need to investigate you for multiple sclerosis where the disease phase is characterized by active phase and remissions. It has multiple symptoms and signs and is a diagnosis of exclusion. The symptoms of multiple sclerosis are loss of balance, muscle spasms, numbness in any area, problems with walking and coordination, tremors in one or more arms and legs. Bowel and bladder symptoms include frequency of micturition, urine leakage, eye symptoms like double vision uncontrollable rapid eye movements, facial pain, painful muscle spasms, tingling, burning in arms or legs, depression, dizziness, hearing loss, fatigue etc. The treatment is essentially limited to symptomatic therapy so the course of action would not change much whether MS has been diagnosed or not. Apart from clinical neurological examination, MRI shows MS as paler areas of demyelination, two different episodes of demyelination separated by one month in at least two different brain locations. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons, transmit nerve signals slower than non-demyelinated ones and can be detected with EP tests. These are visual evoked potentials, brain stem auditory evoked response, and somatosensory evoked potential. Slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI in addition, a spinal tap. Therefore, it would be prudent to consult your neurologist with these concerns. Hope this helps. Take care.

shawnl0506 · Answer

I had an ear infection when all of this started.  Morphology showed atypical reactive lymphs and stomatocytes then progressed to neutrophils with left shift.  EVP has not been done.  Other doctors have said cranial nerves 2 thru 12 grossly intact.  There are demylinating plaques but they seem to be healing on their own. One of the first plaques was a ring enhanced at the gray white matter junction.  I have also had pappenheimer bodies show up in the blood work.  With the ear infection I unset the crystals in my ear when vomiting.  I have never had tremors, muscle spasms, coordination issues, nor numbness and the only eye symptom I have had is jaundice.  I have had a lot of viral infections including viral pneumonia and bronchitis.  I had a normal MRI in 2005 then this all started July 31st 2008.  I am totaly confused and don't know where to turn next.  I have also had exposure to Lyme but it is not active at this time.

shawnl0506 · Answer

I had an ear infection when all of this started.  Morphology showed atypical reactive lymphs and stomatocytes then progressed to neutrophils with left shift.  EVP has not been done.  Other doctors have said cranial nerves 2 thru 12 grossly intact.  There are demylinating plaques but they seem to be healing on their own. One of the first plaques was a ring enhanced at the gray white matter junction.  I have also had pappenheimer bodies show up in the blood work.  With the ear infection I unset the crystals in my ear when vomiting.  I have never had tremors, muscle spasms, coordination issues, nor numbness and the only eye symptom I have had is jaundice.  I have had a lot of viral infections including viral pneumonia and bronchitis.  I had a normal MRI in 2005 then this all started July 31st 2008.  I am totaly confused and don't know where to turn next.  I have also had exposure to Lyme but it is not active at this time.