CSF oligoclonal banding

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

CSF oligoclonal banding

Definition:

Thisis a test performed on cerebrospinal fluid (CSF), the clear fluid that circulates in the space surrounding the spinal cord and brain. The CSF contains substances that may be markers for disease.

Oligoclonal bands are immunoglobulins that suggest inflammation of the central nervous system. The presence of oligoclonal bands may be a sign of multiple sclerosis.

Alternative Names:
Cerebrospinal fluid - immunofixation
How the test is performed:

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A lumbar puncture (spinal tap) is performed and the fluid is sent to the laboratory for analysis.

How the test will feel:

Patients will be asked to either sit up or lie down on their side withback parallel to the bed andchin tucked under andlegs curled in the fetal position. The healthcare provider will use the bony protrusions of the hip to determine the most appropriate location to remove fluid. This is usually at the L3-L4 vertebral level.

Subsequently iodine will be used to clean off the area and a sterile sheet will be draped over the surrounding area. In infants and small children, a local anesthetic cream to numb the skin, will be applied about 1 hour prior to the procedure. In adults, lidocaine will be injected under the skin initially, and then deeper such that tissue beneath the skin will also be numbed.

A thin, 20-gauge needle will then be inserted into the interspace between the vertebra. Depending on how much subcutaneous tissue there is, this may require shallow or deeper penetration of the needle. There may be an audible pop when the needle penetrates the dura (membrane surrounding the spinal cord and encasing the fluid).

At this point, fluid will flow out of the needle and be collected in plastic containers. Under normal circumstances, the opening pressure will be measured with a manometer and then about 20-30 cc of spinal fluid will be collected and sent for evaluation under the microscope.

Under experienced hands there should not be any pain. There may be a feeling of pressure when the needle is inserted but with appropriate anesthetic, this should not hurt. Occasionally, some people may feel numbness shooting down the leg. This may be due to irritation of a nerve root and subsides when the needle is withdrawn.

Following the procedure, the patient is advised to remain lying down for an hour or two to prevent low-pressure headache. The entire procedure takes approximately 20 minutes.

Why the test is performed:

This test helps support, but does not confirm, the diagnosis of multiple sclerosis (MS). The presence of oligoclonal bands in the CSF must be interpreted in the context of clinical findings and other laboratory results.