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Had lumbar puncture to investigate memory and speech issues. MRI done. Looking for suggestion

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Recently had lumbar puncture to investigate some memory and speech issues (unable to find right word at times, tongue tied, issues reading aloud - stumbling on words I know how to say easily normally). Raynauds in R. Hand. MRI found lesion - possible demyelation in PONS - concern is lumbar puncture right now. Doctor was only looking for banding and was my GP and was unsure what the rest of results meant. hx is mi at 36 and dx with periprheal neuropathy at 38. lumbar fusion x 2 w/post surgical complications. + babinsky. no banding in lumbar found. Test results as follows. Note RBC.WBC and atypical cell count

6/18/12 17:06CSFTYPE FLUID/TUBE #: Tube2 GROSS APPEARANCE: Colorless Clear NUCLEATED CELL: 4 /uL RBC: 29 /uL TOTAL # CELLS: 58 total_# NEUTROPHILS: 3 % LYMPHS %: 73 % MONO/MACROPHAGE: 21 % ATYPICAL CELLS: 3 % GLUCOSE SPINAL FLUID: 61 mg/dL (45-75) PROTEIN CSF: 49 mg/dL (20-50) OLIGOCLONAL IG CSF: No oligoclonal immunoglobulin demonstrated. IGG INDEX CSF: 0.52 (0.28-0.66) IGG CSF: 2.6 mg/dL (0.5-5.9) IGG SERUM: 813 mg/dL (694-1618) ALBUMIN CSF: 26.7* mg/dL (13.9-24.6) ALBUMIN SERUM: 4376 mg/dL (3500-5000)

other blood tests done with lumbar:

06/18/12 15:48CBCWBC: 6.6 thou/uL (3.9-10.7) Hemoglobin Blood: 12.6* g/dL (14.0-18.1) PCV BLOOD: 38* % (41-49) PLATELET COUNT: 261 thou/uL (135-371) Red Blood Cells: 4.40* mil/uL (4.50-6.00) MCV: 87 fL (81-98) MCH: 28.6 pg (27.0-32.0) Mean Corpuscle Hemoglobin Concentration: 32.8 g/dL (31.0-35.0) RDWSD: 42.9 fL (37.4-52.4) Red Blood Cells Width Distribution: 13.5 % (11.1-14.3)
Posted Sat, 4 Aug 2012 in Brain and Spine
Answered by Dr. Neeraj Baheti 20 hours later
Thanks for posting your query.
From the current history with the background history of peripheral neuropathy, AMI, positive raynaud's the possible differentials for your pontine lesion would be an ischemic lesion (infarct) Vs. demyelination. The CSF findings does not support demyelination (Proteins are normal, oligoclonal bands negative, IgG index normal).
And the current infarct shares the same pathology waht lead to an MI at 36
Did your physician told you in past that you may be having vasculitis?
What is your XXXXXXX report?
Why have they initiate dyou on steroids?
Are you a diabetic? What is your lipid status?
You are on atenolol, are you hypertensive? With the history of raynaud's atenolol might not be the best drug. Check with your treating physician.
Hope i have answered your queries.
Should you need any more clarifications i shall be happy answer

Best Wishes,
Dr. Neeraj Baheti
Above answer was peer-reviewed by
Follow-up: Had lumbar puncture to investigate memory and speech issues. MRI done. Looking for suggestion 51 minutes later
I would like to answer your questions to the best of my ability and provide a bit more information. I was tired at the time I was writing but this is some information I included in a question I posed to a dermatologist on this site:

I have had lesions on my face, arms chest and back as well as some on legs and feet. This has been going on for over 5 months and some of the original sores are still present and just when i think they are about to heal they come back. they are round and have clear to slightly yellow drainage and bleed excessively when bothered - even when washing face or other affected area. 2 biopsies have been inconclusive but the last stated that while unconclusive the tissue resembled dermititis herpetiforma. (sp?) I am 46 - male - and conncurrently have been suffering from Raynauds and some neurological symptoms and have had a lesion found in the PONs region of the brain. Some speech problems at times (unable to find right word - tongue tied - and problems while reading aloud. I am (or have been generally well spoken in the past until all of this started at the end of October 2011 with a trip to the ER with trouble breathing. That was determined to be bronchial spasm. Never happened before. The skin lesions started early this year (Feb or so) and have not relented a single day since. Pictured are available at my Google+ page ( YYYY@YYYY ) Thank you.

1) MI was because of hyperlipidemia (sp?)with a triglyceride score of over 1300. Was in XXXXXXX lab quickly stent placed and after recovery no further issues. No longer smoke. No ETOH.
2) Was sent to rheumatologist for suspicion of vascultitis as one my PCP's first moves but that was negative. (had temporal arteritis at early age (ideopathic perhaps - lifestyle was not very good at time). This was in 1995. Cleared with high dose prednisone.
3) Highest XXXXXXX was 18 at the onset of symtpoms in November and has been in the high end of normal since.
4) Steroids have been started primarily to see if they may help with some inflammation that I am having in hands along with facial lesions (see images on the case I sent to dermatologist and on my profile). I am having pain and obvious redness and swelling in digits of hands. Started in R Hand (same hand that I drop almost 50% of everything I pick up.) I would drop only light objects at first but now weight is no factor.) CRP/ANA + other inflammatory markers only mildly elevated a few times during this issue but inflammation is still present. My PCP clearly notes the inflammation as well as severe pitting edema in legs.
5.Currently not diabetic and sugar is well mediated. Cholesterol is 151. Perfect.
6. Atenolol is for rapid heartbeat and mild HTN. We have tried other meds but Atenolol is most effective at controlling heart rate. I have been on this med for over 10 years and it has been well tolerated.
7. To note - have been experiencing severe constipation as well (8 - 10 days and can only go by using stimulant laxitive that liquefy colon contents. Had recent colonoscopy and it was (-) for and blockage, etc. It is as if there is not normal movement of lower intestinal tract.

You didn't comment on the RBC and Atypical cells present in the CSF. My doctor admits that they should not be there but he had not idea what it meant. We were left dumbfounded that he ordered a test that he could not interpret. He was only looking for banding and that is all he reported on.

The MRI report read XXXXXXX An area of T2 hyperintensity is present within the right posterior pons without enhancement on postcontrast images.This likely indicates an area of demyelination XXXXXXX

MRA reads as follows: MRA HEAD: No hemodynamically significant stenosis or aneurysm formation are identified within the intracranial vasculature. There is no evidence of arterial venous malformation. The right PCA demonstrates a fetal configuration with a small P1 segment. The left posterior communicating artery is not visualized and is likely hypoplastic XXXXXXX

I don't know if this information provides any more insight. It would take some time to include all that has occurred since I started to have problems in November. I am attaching a "summary" that was written a short time ago that is more inclusive.

Answered by Dr. Neeraj Baheti 3 hours later
Thanks for giving a detailed history with investigation reports.
I can not access your images submitted to dermatologist.
Atypical cell and RBCs can be seen with CNS Vasculitis/CNS infections/ CNS malignancies
In your case CSF is suggesting chronic meningeal inflammation with normal sugar and proteins and few abnormal cells. These changes are most likely due non infectious meningeal inflammation, possibly immune mediated.
I went through your history, your XXXXXXX was positive. You go for XXXXXXX blot (ds DNA, Anti Ro, La, SSL etc.) Also can go for nerve biopsy. If there is evidence of vasculitis then you may require immunosuppression.
As of now the current episode is more likely to be an infarct (ischemic stroke) and doesn't look like demyelination.
consult a neurologist/Rheumatologist. He/she will guide you appropriately.

Best Wishes,

Above answer was peer-reviewed by
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