Help with interpreting LP results

[miza_b]

I'd like to start by stating that I have a history of symptoms dating back to Fall of 2006.  My symptoms include numbness/tingling in face and scalp, pruritus, headaches, urinary retention, numbness in lower abdomen, multiple paresthesias, cognitive problems

I recently went into retention again without any warning and my neuro had me check myself into the hospital to get an MRI of my brain and spinal cord done.  The MRI came back normal, but there was a spot on my spinal cord at about T12-L1 level.  It turns out that this spot was on a previous MRI from a year ago, but they didn't think it was important.  My neuro decided that the next step was to get an LP done w/ an MS panel.  I was impatient and got the results of the panel already.  I haven't gone over the results yet with the doc, and I will, but I was wondering what others out there thought.

So, I have gone through everything and it all seems normal except these

CSF Protein             65 H
CSF Albumin           43.7 H
Monocytes               53 H
Oligoclonal Bands    Negative

I can post the rest, but it all seems within range.  I know that one of the deciding factors in diagnosing MS is oligoclonal banding.  If it isn't MS, what else could it be?  What would make those three high and cause me problems off and on over a three year period?

Like I said, I'll talk to my neuro next week, but I'm anxious and want to know.  If anyone has any suggestions, let's hear them.

Thanks for your help

[Quixotic1]

Ahhhh....I see what the problem was.  Your WBC's are NOT elevated.  There are only 5. The monocytes were 53% of the total and the other were 47% lymphocytes. Tthat makes sense.  So that is not an abnormal value.  The WBC/Diff means how many cells were counted to achieve the "differential" percentages.

The O-BAnds were likely the same two seen in the serum, so they were not "unique" to the CSF - so negative there.

The IgG Index does not indicate excessive antibody production in the CSF over the serum, so that is negative.  Those are ther only two that mean anything.  Most of the other numbers there are used to calculate the IgG Index.

Quix

[miza_b]

Thanks for the quick reply, Quix.  I am planning on sticking around for a while and will keep you up to date on what the doctor says.

I'll just put the rest of the stuff on the labs

Csf WBC                  5
Csf RBC                   0
Csf Gluc                   65
Csf VDRL                 NEG
Olig CSF                   2
Olig Serum                2
Csf IgG Index             0.57
Csf IgG                      6.9
Csf IgG/Alb                0.16
Serum IgG                 1290
Serum Alb                 4670
Ser IgG/Alb                0.3
Csf Synth Rate           6.04
Lymphocytes             47
WBC/Diff                   30

I talked with my neuro, who said that it wasn't bad enough to diagnose me with anything.  From what I have been reading, protein, albumin, and monocytes being elevated can be indicative of transverse myelitis.

Let me know what you think :)

[Quixotic1]

Hi and welcome to the forum.  I'm really sorry that you are going through this.  You do have quite an assortment of symptoms that are often seen in MS.

The lesion at T12 is right at the bottom of the spinal cord itself and maybe well be the reason for the urinary retention.

The LP is interesting.  The mildly high protein is consistent with the CSF of MS.  The albumin doesn't mean much.  The negative oligoclonal bands are what they look for to cinch a diagnosis of MS, but a negative result does NOT (repeat NOT) rule out MS, even though many neuros say it does.  Do you have the result of the IgG Index?  that is another result that can be considered a positive result.

However, the presence of 53 monocytes is very abnormal and not part of what you see in MS.  Your docs may be doing more testing to see why the monocytes are so high.  I wouldn't presume to comment on it.  Typically you would find zero to a few white cells in the CSF and they would be polys or lymphocytes.  So, the monocytes are surprising.

I hope you stay around and let us know what your doctor says.

Quix