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Dr. Andrew Rynne

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MRI showed white matter disease. Lumbar puncture and blood test done. Suggestion on lab test report

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Dr. Ganesh Sanap

Radiologist

Practicing since :2007

Answered : 561 Questions

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Posted on Thu, 10 Jan 2013 in X-ray, Lab tests and Scans
Question: I have had two MRIs, both showing white matter disease, so the other day I had a lumbar puncture done. Some of my blood work came back, but the MS panel has not yet. My neurologist posted this on my private health page through my provider, but since it a Sunday and tomorrow is Christmas Eve, I doubt I'll be able to have him explain these to me.
This is what my labs said:
COLOR Colorless CLARITY Clear
WBC COUNT 3 (value) 0-10 (reference) /mm3 (units)
RBC count 204 flagged High 0-0 (reference) /mm3
neutrophils 20 flagged high 0-6 /mm3
lymphocytes 51 40-80 /mm3
mononuclears 29 15-45 /mm3
cells counted 35
Please help me understand this. Thank you!!
doctor
Answered by Dr. Ganesh Sanap 1 hour later
Hi XXXXXXX
Thanks for writing in.
Out of all cells in CSF fluid , RBCs (red blood cells) and neutrophils are elevated. Increased red blood cells count can be seen in many conditions including multiple sclerosis. Increased neutrophils can be seen in any inflammatory condition and is not specific for MS.
However, a CSF report can not be used as a stand alone diagnostic tool. It needs to be corroborated with clinical history and MRI findings. In MRI there are multiple white matter lesions at different locations.
Considering your history, MRI and CSF report , possibility of multiple sclerosis can not be ruled out. I would suggest you see your physician soon.
Let me know if you have any more questions.
Regards.
Above answer was peer-reviewed by : Dr. Aparna Kohli
doctor
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Follow up: Dr. Ganesh Sanap 16 hours later
Thank you for your help. My physician just released another report.

It says:

History--tremors in the hands and sensation in the toes for about a year. White matter lesions on MRI of the brain on 11/29/12. Multiple sclerosis.

Under fluoroscopy, a 20 gauge spinal needle was advanced into the thecal sac at the L4-L5 level. Subsequently, 6.5 cc of clear CSF was collected and sent to the lab for evaluation. Those results are pending. Opening pressure was also measured. This is 13 cm/H2O. Normal is 10 cm/H2O or less.

What could the opening pressure mean?

I will be calling my Dr. as soon as Christmas is over, but in the meantime the wondering is the worst part.

Thank you again for your help. Merry Christmas!
doctor
Answered by Dr. Ganesh Sanap 8 hours later
Hi,
Thanks for writing back.
Opening pressure means a pressure at time when needle enters in CSF space. It is normal in your case. CSF pressure is in range of 10 to 25 mm of H2O . Your pressure is just borderline.
I think no need to worry about that as there may be few variations.
MRI diagnosis is consistent with CSF reports.

I understand your situation but positivity always helps.
Merry Christmas.
Regards.
Above answer was peer-reviewed by : Dr. Aparna Kohli
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