Re: on Diagnosing MS (repeat email--DEBBIE)

[Guest guest]

This is a great reference, Sharon!

You know, when I tell people that I have MS, so often they say, "I' m

sorry!" Sheesh! I have to tell them, "Hey, no problem! I'm getting

along fine!"

Do you all find people thinking that you are worse than you are, just

because you have the dreaded Initials attached to you?

Sam

in crisp cool Boston

Sharon Marsden wrote:

DIAGNOSING MS

http://www.albany.net/~tjc/diagnosis.html

The

Neurologist requires clinical evidence that your Neurological deficits,

indicate involvement of at least TWO

different areas (Functional Systems) of the CNS, with documented Neurological Signs

occurring at TWO

separate and distinct time periods; and ALL other possible Neurologic

causes must have been eliminated. ("Poser Criteria")

1 - Poser, C.M.; Paty, D.W.;

Mc, W.I.; Scheinberg, L.; Ebers. G.C.; eds.

"The Diagnosis Of Multiple Sclerosis" New York:

Thieme-Stratton Inc.; 1984

2 - Poser CM, Paty DW, Scheinberg L, et al.

"New Diagnostic Criteria For Multiple Sclerosis: Guidelines For

Research Protocols"

Ann Neurol 1983;13:227-231

Multiple Sclerosis is

essentially a clinically determined diagnosis of exclusion. There are NO tests

which are specific for MS, and NO

single test is 100% conclusive. Conventional MRIs only image some lesions (Macroscopic

ones), which are NonSpecific as to cause and do NOT fully

account for MS.

Therefore, several tests and procedures are needed to eliminate ALL

other possible causes and firmly establish a diagnosis of MS. They include the

following:

·

Diagnostic Categories

·

Medical History

·

Neurological Examination

·

Evoked Potentials

·

Magnetic Resonance Imaging

· Lumbar Puncture (Spinal Tap)

http://www.msnews.org/faqmri.shtml

Questions

answered by Dr. Herman Weintraub

QUESTION: I had my third MRI in five years and this

one had one 4mm lesion in the front left lobe, with hyperintensities in

periventricular areas. The radiologist reported it as normal for a

female 41 years of age. Why? Do they leave this in the hands of the

neurologist, who has the history and physical info on the patient to

diagnose? The other two MRI's showed nothing.

10/11/99 ANSWER: The only person who can properly interpret

your MRI is your neurologist. A radiologist can suggest various

possibilities for a lesion, but it is up to the doctor who knows your

history and exam to decide whether a finding is normal or abnormal.

There are some age-related changes in the brain that can sometimes

mimic or overlap with MS lesions, but these usually do not appear until

the 50s or 60s; you're too young for these lesions!

QUESTION:

What is the

difference between white matter and gray matter? What significance is

a finding of lesions in both on an MRI? I'm newly diagnosed with MS.

8/6/99 ANSWER: White matter includes the pathways that

contain myelin, allowing the nerve cells to talk to one another. The

gray matter is the thinking part of the brain; it contains the cells

that do the hard work of generating electrical impulses. It is not

appreciated that there is white matter (myelin) in the gray matter; MS

lesions can involve the gray matter at times, sometimes confusing

neurologists and their patients. It is unusual but not unheard of to

see typical MS type lesions occasionally involving the gray matter.

QUESTION:

I have vision and

bladder problems, tingling, balance, speech and numbness with my MS.

I’m presently taking Avonex injections. I was

diagnosed with MS 2 years ago and have since changed to another

neurologist. The new neuro said my lesions have

not changed in two years and thinks that I do not now have MS. Must there be a change in lesions or can they stay

the same?

7/10/98 ANSWER: It is not unusual for brain

MRI lesions to plateau and remain unchanged between MRIs.

This does not in any way contradict the diagnosis of MS. It does suggest that the “burden” of disease

accumulation has slowed.

QUESTION: I am undiagnosed, but my MRI reads "subtle

linear hyperintensities in the deep white matter adjacent to the

ventricular atria". Can you explain this?

7/1/99 ANSWER: MRI changes consistent with MS include

hyperintensities on the T2-weighted images. These are often in the are

around the ventricles, which would include the ventricular atria.

There is a differential diagnosis that accompanies these white spots:

these can be seen in demyelinating disease (MS) but also with normal

aging, strokes, infections, etc. You are entitled to review your MRI

film with your neurologist or the physician who ordered it.

QUESTION: I have had 2 MRI's with atypical positive

findings in the corpus callosum. I was first diagnosed with MS 2

years ago with left sided weakness and paralysis, bilateral ON, bladder

and diaphragm spasticity. I have been getting progressively worse over

the last 11 months and have been unable to work. I now have cognitive

deficits. Can you explain corpus callosum involvement and if it causes

speech, word retrieval, memory loss, confusion, and poor reading

comprehension? I would like to go to law school but unable to

stabilize.

5/4/99

ANSWER: The corpus

callosum is a common site of involvement in MS by MRI, but it is not a

site where we can clearly localize specific neurologic findings. Some

authorities consider it a "silent area" of the brain, where a person

can develop sizable growths, such as brain tumors, without much finding

on the physical neurologic exam. As you point out, the corpus callosum

is a pathway for transferring information between the right and left

brains, so it is a critical linkage in the brain's information

highway. There is MRI evidence indicating that corpus callosum atrophy

is better correlated with cognitive dysfunction in MS than physical

dysfunction.

QUESTION: I have had repeated brain MRIs. All have

been negative. However, symptoms and neurological exams repeatedly

confirm that I have MS. I have been diagnosed for 15yrs, with relapses

about twice a year. Why are the MRIs still normal?

3/10/99 ANSWER: A small proportion, probably < 5% of

persons with clinically definite MS may have persistently normal MRIs.

Another possibility is that the disease involves the cervical or

thoracic spine, which is often not imaged, and which sometimes is of

poor resolution to pick up a plaque. I recently had the experience of a

patient who underwent an "open MRI" for fear of claustrophobia; this

was interpreted as negative. The brain MRI showed some suspicious

lesions and she actually underwent brain biopsy. The biopsy was

consistent with MS. When she had a "closed MRI," with appropriate

sedation to prevent claustrophobia, the MS lesions appeared. Finally,

there is the possibility that you don’t have MS, but something that can

mimic it, like lupus or other syndromes. MS is still a clinical

diagnosis, based on signs and symptoms. No specific lab test can make

or break the diagnosis.

QUESTION: On my last MRI I had a report come back

of a 1 cm X 5-mm focal area of increased signal present in the right

globus pallidus. It appears to abut the posterior limb of the right

internal capsule and putamen. The report says there is fluid now

collected in it and it could be ischemia or a focal area of

demyelinization. My neurologist says he believes it to be an old area

of attack of MS plaque that has filled with water. I had another dr.

(not a neurologist) tell me I should be checked for strokes. I have no

head injuries. My question is, can MS plaques do this or should I be

checking for vascular problems? Any help on this will be much

appreciated.

7/10/98 ANSWER: Your neurologist is likely correct. If

there is tissue loss anywhere in the brain, that area is eventually

filled up with CSF (brain water). There are only three things in the

brain—brain tissue (the "salami"), blood, and spinal fluid. If brain

tissue is lost, for whatever reason, the spinal fluid takes its place.

QUESTION: I was diagnosed with MS about 15 months

ago through symptoms, MRI, blood test, and spinal tap. Lesions have

appeared on every one of my MRIs. The last MRI showed lesions but ones

that were not "active." Currently I am experiencing ON in my right eye.

I am feeling sharper pains behind my eye this time compared to my first

ON experience. My MRI scan however, did not pick up any change from

five months ago. Is it possible to have an exacerbation and not see a

new or active lesion on the MRI?

7/10/98 ANSWER: There are limitations to the sensitivity

of the MRI to detect new lesions. It has become apparent that

gadolinium enhancement reflects blood-brain-barrier breakdown with the

formation of new lesions. However, established lesions can enlarge on

their own without obvious evidence of gadolinium enhancement. We think

now that once lesions become established within the brain, they take on

a life of their own, and can activate and de-activate based on as yet

unidentified signals. So the answer to your question is that it’s quite

possible to have a flare-up of MS representing activation of an

established lesion even without evidence of gadolinium enhancement.

Sharon (list owner)

"Happiness is not a destination. It is a

method of life." -Burton Hills

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