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What Do My Lumbar Puncture Test Results Indicate?
Question: Hi Doctor. I just received the results of my lumbar puncture looking for CIDP. The only results that were off were my CSF LYMPHOCYTES 37 and my CSF monocytes 6. I cannot find anything that talks about low or decreased issues. I go to MAYO clinic on July 7th to Neurology. I've had severe peripheral neuropathy for a year and a half.
THANK YOU
THANK YOU
Brief Answer:
Read below.
Detailed Answer:
I read your question and that part of your report.
If the clinical suspicion is one of CIDP then what is expected to be found in the cerebrospinal fluid is an elevated protein level. That is the most marked change in this condition especially as it is not accompanied by a significant rise in cell count as would happen in other infectious or inflammatory conditions. However there may be also a mild increase in lymphocyte levels in about 10% of patients.
So what I am trying to say is that the cell count results you provide are not evaluated alone but together with changes in protein and glucose, only that result is not enough to say anything. Whether that 37 value can be present in CIDP, yes, as I said a mild rise (up to 50 lymphocytes) may be present in 10% of CIDP patients. But alone that means nothing as such a rise may happen in other conditions, so protein and glucose levels must be measured as well.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question and that part of your report.
If the clinical suspicion is one of CIDP then what is expected to be found in the cerebrospinal fluid is an elevated protein level. That is the most marked change in this condition especially as it is not accompanied by a significant rise in cell count as would happen in other infectious or inflammatory conditions. However there may be also a mild increase in lymphocyte levels in about 10% of patients.
So what I am trying to say is that the cell count results you provide are not evaluated alone but together with changes in protein and glucose, only that result is not enough to say anything. Whether that 37 value can be present in CIDP, yes, as I said a mild rise (up to 50 lymphocytes) may be present in 10% of CIDP patients. But alone that means nothing as such a rise may happen in other conditions, so protein and glucose levels must be measured as well.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr.Taka,
Thank you for your quick reply. I have attached a few reports that may be helpful to you. My immune system is low also. I can't get in to see my neurologist until XXXXXXX 13th and I have a few new issues that are really concerning me. For the last month, my hands and feet feel frozen, but are warm to the touch. They also go almost completely numb. The Gabapentin is not controlling the neuropathy pain. I don't know what else to try. I will not take pain medicine.... I have been trying for a year and a half to get an answer. I also had severe nerve pain in my neck for the two years prior to this. The pain did not match my herniated disks and most doctors just wrote me off. I learned to live with the pain. In February of 2015 I was on antibiotics. I woke up one morning and could not move at all. My body just quit on me. The pain was terrible and my husband had to help me walk. The October prior to that (2014), I landed in ICU with some type of respiratory failure. I almost died. I was in ICU for 7 days. They still don't really know what happened. I was a previous smoker and they said that could have been the cause, but I was 43 and overall healthy other than the smoking. I have no respiratory issues now and I am very healthy other than the severe neuropathy. In 2013 my pinkie and ring figure went numb on my left hand. They said it was an ulnar nerve compression and did surgery. They are still both numb. Also in Sept 2015 I had bloodwork run and my body had no immunities to pneumonia. After I received the shot my immunities returned to normal.
I don't even know what im asking. I guess my biggest question is the cold and numbness of my extremities. Should I push to get a sooner appointment. I feel like I am getting worse everyday.
Thank you , XXXXXXX Braun
Thank you for your quick reply. I have attached a few reports that may be helpful to you. My immune system is low also. I can't get in to see my neurologist until XXXXXXX 13th and I have a few new issues that are really concerning me. For the last month, my hands and feet feel frozen, but are warm to the touch. They also go almost completely numb. The Gabapentin is not controlling the neuropathy pain. I don't know what else to try. I will not take pain medicine.... I have been trying for a year and a half to get an answer. I also had severe nerve pain in my neck for the two years prior to this. The pain did not match my herniated disks and most doctors just wrote me off. I learned to live with the pain. In February of 2015 I was on antibiotics. I woke up one morning and could not move at all. My body just quit on me. The pain was terrible and my husband had to help me walk. The October prior to that (2014), I landed in ICU with some type of respiratory failure. I almost died. I was in ICU for 7 days. They still don't really know what happened. I was a previous smoker and they said that could have been the cause, but I was 43 and overall healthy other than the smoking. I have no respiratory issues now and I am very healthy other than the severe neuropathy. In 2013 my pinkie and ring figure went numb on my left hand. They said it was an ulnar nerve compression and did surgery. They are still both numb. Also in Sept 2015 I had bloodwork run and my body had no immunities to pneumonia. After I received the shot my immunities returned to normal.
I don't even know what im asking. I guess my biggest question is the cold and numbness of my extremities. Should I push to get a sooner appointment. I feel like I am getting worse everyday.
Thank you , XXXXXXX Braun
Brief Answer:
Read below.
Detailed Answer:
Thank you for the additional information and the reports.
I still must say that the reports are not complete. I fail to see any mentioning of the proteins in the lumbar puncture report, which is necessary for any cerebrospinal fluid analysis, but even more so if suspicion is for CIDP. So I can not explain why that is not included, I imagine that it is in a separate report from cell study, it is something really basic so I am sure it has been done.
The other report has a borderline result for anti-sulfatide antibodies which have been linked with autoimmune neuropathies, it is not a clear cut result though.
I am not sure what the bite photo refers to, you do not mention any bite in your post, nor if it has been discussed with your physicians and if the possibility of an infectious cause like Lyme disease has been considered with lab tests (my guess would be yes, as it is commonly among the tests for neuropathy even in the absence of any history of bite).
The work-up for a neuropathy is a very extensive one (unless there is an obvious cause) so it is hard to point to an origin with the limited data you provide, I am sure you have had many other tests apart from those reports. Regarding your question on whether to try to anticipate appointment given your worsening, my answer would be yes, you should try to get an earlier appointment if you are progressively worsening, even if the cause can not be definitely cleared at times treatment with medication which alter immune response may be necessary.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Thank you for the additional information and the reports.
I still must say that the reports are not complete. I fail to see any mentioning of the proteins in the lumbar puncture report, which is necessary for any cerebrospinal fluid analysis, but even more so if suspicion is for CIDP. So I can not explain why that is not included, I imagine that it is in a separate report from cell study, it is something really basic so I am sure it has been done.
The other report has a borderline result for anti-sulfatide antibodies which have been linked with autoimmune neuropathies, it is not a clear cut result though.
I am not sure what the bite photo refers to, you do not mention any bite in your post, nor if it has been discussed with your physicians and if the possibility of an infectious cause like Lyme disease has been considered with lab tests (my guess would be yes, as it is commonly among the tests for neuropathy even in the absence of any history of bite).
The work-up for a neuropathy is a very extensive one (unless there is an obvious cause) so it is hard to point to an origin with the limited data you provide, I am sure you have had many other tests apart from those reports. Regarding your question on whether to try to anticipate appointment given your worsening, my answer would be yes, you should try to get an earlier appointment if you are progressively worsening, even if the cause can not be definitely cleared at times treatment with medication which alter immune response may be necessary.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Taka,
Thank you so much for your reply. You are correct that the reports are not complete. I finally spoke to my doctor today. They either did not run the protein test or did not include the test results. They are trying to get to the bottom of it. I have been waiting for the results since the procedure on May 5.
My doctor increased my Gabapentin from 900mg to 1800mg, slowly over a 3 week period. She also ordered IVIG treatments. She is concluding from my new blood work, and the last year of results that it is CIDP. She said even if I do not get my protein results, that she still wants me to go ahead with treatment.
It looks like we are finally moving forward. I just wanted to say thank you for encouraging me to contact her. It made a huge difference.
Thank you, XXXXXXX Braun
Thank you so much for your reply. You are correct that the reports are not complete. I finally spoke to my doctor today. They either did not run the protein test or did not include the test results. They are trying to get to the bottom of it. I have been waiting for the results since the procedure on May 5.
My doctor increased my Gabapentin from 900mg to 1800mg, slowly over a 3 week period. She also ordered IVIG treatments. She is concluding from my new blood work, and the last year of results that it is CIDP. She said even if I do not get my protein results, that she still wants me to go ahead with treatment.
It looks like we are finally moving forward. I just wanted to say thank you for encouraging me to contact her. It made a huge difference.
Thank you, XXXXXXX Braun
Brief Answer:
Thank you!
Detailed Answer:
Thank you for your appreciative words XXXXXXX I am really glad I was able to help.
Hope you will feel better soon.
Thank you!
Detailed Answer:
Thank you for your appreciative words XXXXXXX I am really glad I was able to help.
Hope you will feel better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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