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Feeling off balance, lightheadedness and MRI stable with white spots. Have MS and had CSF with blood test. Meaning?

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Allergist and Immunologist
Practicing since : 1999
Answered : 584 Questions
I have had symptoms of off balance, lightheadedness and an abnormal MRI (stable white spots and 1 plaque for 15 years) and now extremely fatigued which lead them to r/o MS. I am a well trained triathlete and bicycle racer (since 1997). I recently had a lumbar puncture and my serum IGg , Albumin normal but I had 1 Oligoclonal band in the CSF and 2 paired bands in the CSF and serum. Is it possible that this could be just nothing or something like allergies and not really serious?
Posted Wed, 17 Jul 2013 in Asthma and Allergy
Answered by Dr. Sujoy Khan 4 hours later

Welcome to Healthcare Magic and thank you for writing to us.

The test that you had (CSF puncture for Igs and IgG index) is to check whether there is intrathecal production of Immunoglobulins (i.e., production of Igs ONLY in the cerebrospinal fluid). The IgG synthesis rate in CSF is high in MS, and hence one of the reliable tests for MS.

The CSF IgG index is calculated as follows:
[CSF IgG/CSF Albumin]/[Serum IgG/Serum Albumin], normal range 0.23-0.64

However, in this case there is NO band in the serum, and in your case there is..which means there is production within serum and leakage into CSF.
You need to get Serum Free Light Chains (Kappa and Lambda) levels checked to exclude the possibility of myeloma. Serum Calcium, Phosphorus, Complete blood count, urea, creatinine blood tests need to be checked as well.
A Haematology review is required to review the results, and to see if a bone marrow test is required.

Allergies do NOT cause abnormality in this blood test (the CSF test that you had) so this needs an urgent review.

I hope this was useful.
Best Wishes.
Above answer was peer-reviewed by
Follow-up: Feeling off balance, lightheadedness and MRI stable with white spots. Have MS and had CSF with blood test. Meaning? 1 hour later
All my blood chemistries are normal, so would this r/o myeloma?
Answered by Dr. Sujoy Khan 14 minutes later

Normal blood chemistry tests is indeed good news - that there is no systemic involvement but it is best to get the other tests done to be completely sure.

Please talk to your Doctor who requested this test to refer to a Haematologist if he or she is not one.

Best Wishes.
Above answer was peer-reviewed by
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