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| *Women health>>>Multiple Sclerosis |
Can someone have Multiple Sclerosis even if their MRI shows no myelin damage? Is MRI the only diagnostic tool? |
I'm having some issues that seem to indicate MS. Although I haven't started the routine testing, I'm just curious about the procedure. I know that an MRI that shows myelin damage or lesions is the basic diagnostic criteria, but what if my MRI is normal? Could it still be MS? I guess what I'm asking is, Is the MRI an error-proof way to make a diagnosis of MS or can you actually have MS even though the MRI may not show significant myelin damage? I just want to walk into my Dr. office with a little knowledge about the procedure, testing and diagnosis. C'mon you health professionals out there....help me out on this one! An MRI does not show myelin damage. An MRI is used to obtain an image of the brain to show if lesions are present. Myelin damage in MS patients takes years to show up. At the early onset of MS, a person does not have lesions. And yes, you could have a perfectly normal MRI and still have MS. It is not unusual for it to take years to obtain a definitive diagnosis for MS. Doctors can also do a spinal tap to help in determining if you have MS. The spinal fluid sometimes will contain the broken down components of myelin. But ten percent of people who have MS will not have any myelin in the spinal fluid. A spinal tap is not absolute proof that a person has MS. Hence the spinal tap could also indicate that you do not have MS even though you might actually have it. I strongly suggest that you go to a neurologist who specializes in MS to run the tests. Nerve conduction tests will also not show if a person has MS if the disease is in its early stages. It takes a tremendous amount of training to determine if a person has MS, and a general neurologist could easily make the wrong determination. Hi! I just had to look up MS tonight for one of my OR cases tomorrow, and my textbook has a section on how it is diagnosed. It says that it can be diagnosed based on clinical features (your exam and symptoms, history) alone or in combination with other tests, such as oligoclonal abnormalities of immunoglobulins in cerebrospinal fluid. That test is a tad beyond my scope of understanding, but it means that you could have a spinal tap done and your spinal fluid can be checked for those markers. Also, you could undergo testing called Somatosensory evoked potentials (SSEP) that could show slowed nerve conduction indicating demyelination of your nerves. It also discusses MRI and how it is a sensitive indicator, but these other tests can be used as well. It sounds to me like you can have MS and it not show up on MRI (especially early on). I encourage you to talk more with your doctor about your concerns and ask him/her about the best testing methods. I hope everything gets sorted out, and that it's not MS or something else serious. Good luck to you! Anesthesia and Co-Existing Disease (4th edition) Robert K. Stoelting and Stephen F. Dierdorf You can still have MS even if the MRI shows no lesions. Usually MS is diagnosed on the basis of neurological examinations (test of reflexes), symptoms, MRI and lumbar puncture results - also most neurologists will test for other diseases that can mimic MS, like Lyme disease (this is done with a blood test). Some neurologists will add an EEG on top of that. The order of tests for me were: symptoms blood test reflex test EEG MRI Lumbar puncture I received my diagnosis after the MRI-scan - the lumbar puncture was required to confirm it. Hi Yes you can have MS and not have lesions visible on MRI. There are lots of reasons why. The one I inderstand best is because they can be deep in the brain and also on the optic nerve. Make sure when you do schedule an mri it is with and without contrast and... make sure the do the spine as well, not just the brain. Many more doctors are now willing to dx based on clinical evedince and evidence of 2 or more recorded exacerbations. Good luck to you, Gina Clinically, a diagnosis of MS can be made when a patient exhibits two separate symptoms disseminated by space and time. So if you have two symptoms in separate systems (example: optic neuritis and balance/gait problems) at different times, barring any other causes, a diagnosis of MS could be made. Supporting tests such as CSF analysis, EP (evoked potential) tests and MRIs can be done to confirm the findings, but they are not necessary to make a clinical diagnosis. If an MRI came out completely clean (no lesions, all else normal), a neurologist may question a diagnosis of MS, and do continued tests. But MRI alone is not enough to make (or break) a diagnosis. Clinical observation is preferred, using clinical correlation to enhance and reinforce the finding. Lately, however, neurologists are comfortable making an "initial" diagnosis of "probable MS" with one clinical symptom and positive MRI correlation, because MRIs are *that good* at assisting a diagnosis. MRIs can show certain shapes of lesions and locations of lesions that are only caused by MS and nothing else. So a positive MRI and a clinical symptom is enough to call it "probable MS" and begin treatment, according to most neurologists. HTH Dx'd with one symptom and correlating MRI. Started treatment right away, and <knocking on wood> have been symptom-free for almost 18 months. |
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