Upon disruption of the blood-brain barrier or after introduction of blood into the CSF samples during a traumatic tapping, banding can be detected in a matching pattern in both CSF and serum. Multiple myeloma and other monoclonal gammopathies, as well as some viral infections, are characterized by the presence of immunoglobulin banding in serum. The investigators stated that performing the repeat lumbar puncture too soon (eg, less than 12 hours) after the first could still produce equivocal results, while performing the second puncture too long after the initial one could put the patient at greater risk for morbidity and mortality, due to a missed diagnosis.Īlthough detection of oligoclonal bands is most often associated with multiple sclerosis, other causes of oligoclonal banding should be excluded. According to the study, the timing of the second puncture must be determined on a case-by-case basis, with repeat punctures in the report being performed an average of 2.4 days after the traumatic puncture. However, a retrospective study by China et al found that when a repeat lumbar puncture was performed on patients after the initial, traumatic one, it was possible to determine that xanthochromia was absent, thereby ruling out the possibility of subarachnoid hemorrhage. This frustrates the ability to determine whether xanthochromia, and thus subarachnoid hemorrhage, is present. Typically, high levels of oxyhemoglobin occur in CSF fluid obtained through a traumatic lumbar puncture, in which red blood cells enter the subarachnoid space via direct needle puncture.

Guillain barre csf findings