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I have had my MRI of the brain and lesions were present. Now I'm scheduled for an MRI of the cerival and thoracic spine.

I quess I'm confused. If lesions show up in these next MRIs what does that mean? :confused: Do only MS sufferers have lesions on the spinal cord? If Lesions are present do Neuros generally do a lumbar puncture next? I quess what confuses me is why, if they need to have a complete picture, do they do these tests one at the time? Which test, spinal, cervical, thoracic MRI or lumbar puncture tells the doctors whether or not to diagnose MS?

Just wondering.

Naomi :wave:
Hi Naomi,
MS lesions can be throughout the brain and spine. If your doctor suspects you have MS then he may want a complete picture of what is happening in your body. I think it's great that you are getting a baseline at this point. A lot of doctors aren't so thorough.

If your clinical symptoms and your MRI's are conclusive enough, he may not order an LP. That was my daughter's situation. Between the films and her presenting symptoms and blood tests to rule out other possibilities it was quite obvious.

I hope everything turns out well for you.
Take care,
Hey Naomi...

I share your confusion!

I noticed symptoms and had severe left leg weakness in Jan 03. At that time I had a brain MRI showed 4 lesions. The neurologist said nothing was wrong with me. My GP sent me to another neurologist for a 2nd opinion. He said my problems were related to Anxiety.

I got pregnant and had my baby in February of this year. By May, I was doing really bad. I didn't want to go back to the second neurologist. I waited and one day starting having problems with my eyes. Went to an Opthalmologist who suggested I go to another neurologist.

I went to this new neurologist last Thursday. She is an MS Specialist. She said that at this point, we know that something IS wrong, but it's a matter of ruling out all other possibilities since the lesions on the MRI are new and could be indicative of a number of possibilities.

She also said that with MS it's more of a diagnosis of interpretation...sometimes the lesions on MRI are quite typical in pattern and location, other times they are not. One neurologist could look at it and say you were fine another could match it up with your symptoms and say something was wrong.

Consider yourself lucky that your neurologist is doing such a thorough job trying to figure out what is causing the lesions.

My neurologist also explained the spinal tap as more of a 50/50 indicator that someone has MS. If the test is positive, it only means you COULD have MS, but it is helpful in diagnosis. If it's negative, it means nothing. Some people with MS have a normal LP. She said she had one patient with clinically definite MS not have a positive LP for 4 years after her dx.

She ordered a spinal tap which I had yesterday, Visual Evoked Potentials for Monday, and another brain MRI for Tuesday.

Please keep me updated on how your tests go!
Hi Everyone,
Here are a few (of many) possible conditions that would result in 'lesions' on the MRI:

[B]Condition[/B] - [I]MRI Features [/I]

[B]Multiple Sclerosis[/B] - [I]Multifocal, asymmetrical, periventricular lesions [/I]

[B]ADEM[/B] - [I]Can be identical to MS. Symmetrical cerebral, basal ganglia or cerebral lesions in some[/I]

[B]Ageing[/B] - [I]Usually less extensive than MS. Discrete lesions. Little posteria fossa involvement[/I]

[B]Behcet's syndrome[/B] - [I]Prominent brain stem involvement[/I]

[B]Fat embolism [/B] - [I]High signal lesions on T1-weighted images, high or low signal on T2-weighted [/I]

[B]HIV encephalitis[/B] - [I]Patchy or punctate white matter lesions, commonly involving basal ganglia. Diffuse pattern in AIDS dementia complex [/I]

[B]Irradiation[/B] - [I]Diffuse periventricular and sub-cortical lesions[/I]

[B]Leucodystrophies[/B] - [I]Various patterns of extensive symmetrical white matter abnormalities; atrophy[/I]

[B]Migraine[/B] - [I]A few more discrete lesions than age-matched controls [/I]

[B]Neurosarcoidosis[/B] - [I]Can be identical to MS but also large parenchymal lesions, prominent basal involvement and diffuse menigeal enhancement [/I]

[B]Phenylketonuria[/B] - [I]Periventricular and sub-cortical changes [/I]

[B]Subacute sclerosing[/B] - [I]Few scattered white matter lesions
panencephalitis [/I]

[B]Systemic lupus arterial [/B] - [I]Many sub-cortical lesions; lesions involving
erythmatosus territories [/I]

[B]Trauma[/B] - [I]Variable [/I]

And there are even more than this, but I just wanted to show that lesions can have a variety of causes from simply aging or migraines to much more complicated problems.


I know you have been wondering why you are having to undergo various diagnostic tests. Basically, in April, 2001, an international panel in association with the NMSS of America recommended revised diagnostic criteria for multiple sclerosis. Many doctors are trying to adhere to the current diagnostic criteria, but others still haven't caught up or have chosen not to follow this recommendation. These new criteria have become known as the McDonald criteria (named after their lead author). They make use of advances in MRI imaging techniques and are intended to replace the Poser Criteria and the older Schumacher Criteria. I've listed the criteria below. The bold words are the clinical presention, and the italics are what is needed in addition to the clinical presentation in order to get an MS diagnosis.

[B]Clinical Presentation[/B] - [I]Additional Data Needed [/I]

[B]2 or more attacks (relapses) [/B]
[B]2 or more objective clinical lesions [/B]
[I]None; clinical evidence will suffice
(additional evidence desirable but must be consistent with MS) [/I]

[B]2 or more attacks
1 objective clinical lesion [/B]
[I]Dissemination in space, demonstrated by:
or a positive CSF and 2 or more MRI lesions consistent with MS
or further clinical attack involving different site [/I]

[B]1 attack
2 or more objective clinical lesions [/B]
[I]Dissemination in time, demonstrated by:
or second clinical attack [/I]

[B]1 attack
1 objective clinical lesion
(monosymptomatic presentation) [/B]
Dissemination in space by demonstrated by:
or positive CSF and 2 or more MRI lesions consistent with MS
[B]and [/B]
Dissemination in time demonstrated by:
or second clinical attack [/I]

[B]Insidious neurological progression
suggestive of MS
(primary progressive MS)[/B]
Positive CSF
Dissemination in space demonstrated by:
MRI evidence of 9 or more T2 brain lesions
or 2 or more spinal cord lesions
or 4-8 brain and 1 spinal cord lesion
or positive VEP with 4-8 MRI lesions
or positive VEP with <4 brain lesions plus 1 spinal cord lesion
Dissemination in time demonstrated by:
or continued progression for 1 year

I hope this distillation of information helps answer some of your questions, but more importantly - [I]I hope you don't have MS!![/I]

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