 Re: NPH Possible with negative MRI?
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Sheldon Brown wrote:
> I have been under the care of a neurologist since October of last
> year, still no definitive diagnosis despite 7 MRIs, CT scan, EMG test
> and Lumbar Puncture.
>
> I suffer discoordination of my legs, have had a few falls, and walk
> with a wide, awkward gait, and balance problems particularly associated
> with turing around or getting up from a chair.
>
> The lumbar puncture revealed some olioclonal bands, a sign of possble
> inflammation, but nothing has shown up in any of the MRIs aside from a
> fatty tumor in my right thigh.
>
> I've had MRIs of my brain with and without contrast; also of the upper
> and lower spine, hip and right thigh (the problem seems to be slightly
> worse in the right leg.
>
> My neurologist has me on steroids, which seem to be helping a bit. Ann Neurol. 199
0 Dec;28(6):739-44. Related Articles, Links
> The peculiar thing is the lumbar puncture..for two days after the LP,
> my condition was considerably improved, which I had not expected at
> all. Subsequently someone had suggested that it might be NPH, which I
> had never heard of.
>
> As it happens, I have had slight incontinence issues, mainly urgency,
> but occasional leakage, and had never made any connection.
>
> but my neurologist says not, mainly because my gait isn't as bad as
> what he associates with NPH, and because there's no sign in the MRIs.
>
> What I'm wondering is if it would necessarily always show up in an MRI,
> and if perhaps I just have a mild/early case.
>
> Thanks in advance for any information.
>
> I hate to second guess my neurologist, because I believe he's highly
> competent and I like him, but nobody knows everything..
>
> Sheldon Brown
>
Was your spinal fluid tested by Western Blot and PCR for possible
neuroborreliosis? Or for antibodies bound up in immune complexes?
I'm not saying this is what you have, but it is something that can
produce all the symptoms you describe.
Cerebrospinal fluid immune complexes in patients exposed to Borrelia
burgdorferi: detection of Borrelia-specific and -nonspecific complexes.
Coyle PK, Schutzer SE, Belman AL, Krupp LB, Golightly MG.
Department of Neurology, State university of New York, Stony Brook
11794.
We analyzed cerebrospinal fluid (CSF) from 32 patients with
neurological symptoms and evidence of Borrelia burgdorferi infection (29
were seropositive as determined by enzyme-linked immunosorbent assay, 2
were cell-mediated immune positive, and 1 had been seropositive as shown
by enzyme-linked immunosorbent assay 9 months previously). CSF immune
complexes were found in 22 (69%) of 32 patients; in 18, there was
sufficient sample to isolate immune complexes. By enzyme-linked
immunosorbent assay, isolated immune complexes from 10 of these 18
patients contained antibody specific for B. burgdorferi antigens. The
isotypes were IgG (n = 8), IgM (n = 3), and IgA (n = 2). By immunoblot,
these antibodies were directed against B. burgdorferi 41-kDa antigen and
occasionally against the 33- and 17-kDa antigens. Anti-B. burgdorferi
IgM was present in patients with acute neurological symptoms, was
predominantly complexed rather than free, and decreased with clinical
recovery in the one serial study. Three patients were nonreactive for
free CSF antibodies, but had complexed antibodies to the organism. The
preliminary finding of specific B. burgdorferi components in immune
complexes in CSF suggests an active process triggered by the organism,
even in the absence of other CSF abnormalities.
PMID: 2285261 [PubMed - indexed for MEDLINE]
>
Susan
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