Clean MRI but Constant Symptoms

[Expert Advice is awesome]

Hello, I am a 23 year old male and for the past year and a half I have been experiencing several troubling symptoms involving my balance, vision, and lately my speech. My blood work looks good and i am negative for lyme and all STDs. I have had an MRI done and that came up clean except for congestion in my sinuses. With that said, I constantly experience fatigue in my limbs (not weakness I am still able to pick up heavy things) in addition to tingling sensations ever so often. Currently, my low lips feels as if it is drooping but my face looks fine in the mirror, its just that the muscles in my lower lip seem to be fatigued. My GP believes it is all anxiety related but I find that hard to believe, particularly now that I am experiencing problems with my speech. To reiterate, I do not slur my words, but rather find it difficult to speak quickly and sometimes completely mis pronounce words do to what feels like limited mobility in my low lip area. If anyone has experienced symptoms similar to mine and has any input I would greatly appreciate it. Thanks.

[Dr. Daniel Kantor, MD]

Even more so in TM there does not have to be a positive MRI. MRIs are only 50-85% specific for spinal cord lesions.

MRIs are test that cannot replace a good clinical history and exam.

[Udkas]

Hi,
Thank you for the information.  My symptoms, my neurologists findings etc. on exam all indicate spine.  My symptoms do fit TM (single episode) but neuro now believes I have had an other flare so is testing for lupus etc. that is why I am having first LP done since over 13 years ago and bloodwork and the MRI with the Gad. Both neurologists have both thought there would be lesions in my spinal cord but they never showed up. Because my research said that they were bigger lesions than the ones found with MS I was always uncertain as to why I could produce a clear MRI and my neuro didn't change his mind.

Thank you for your answer, It was really appreciated.  I tended to put all my faith in modern tests but I guess that technology is not yet perfect and findings on exam and patient history must still have some value.

THANK YOU!

[Dr. Daniel Kantor, MD]

I would suggest seing a neurologist -- this is going to be too complex for anyone to figure out online.

[tjammies]

I had a clear mri brain and a lp with bands in blood and serum and brisk reflexes and hoffmans postive and clonus and raised  ANA levels.
I had today a spine mri, no report on it yet, but the first docs looking at it said i should have another lp i think this was s they couldnt see anything on it, but i was told this wasnt the radiologists report on it, just a preliminary look . Do you think its worth having another lp wouldnt it still maybe be an iffy result, i didnt have an infection and wasnt ill at the time, i  aslo had a 10 day headache and dont want that again, but i do want to know whats wrong with me.
thanks

[Udkas]

Just to clarify my question, do you need to have a positive MRI to be diagnosed with TM. Or does the same rules of MS and MRI apply to TM. My current neuro opinion is I have TM but I have no evidence on MRI. This frustrates me no end as I feel I need evidence of my symptoms and neuro's findings.

Cheers,
Thank you in anticipation of a reply.

[Udkas]

Hi there,

Would the same rule apply for diseases like TM.  I am about to have MRI number 6 only this time with Gad. First neuro thought  I had MS and then after subsequent MRI were clear I was told it most likely wasn't but still believed it was neurological due to symptoms and abnormalities on findings.  I have Had waxing and waning symptoms for 13 years. No other health problems.

Neuro number 2 (seeking a second opinion) as I believed I was having worsening of old symptoms and new ones arising did MRI on Telsa3 machine of spine/thoracic and brain, was clear, repeated 12mths later just of spine and now repeating only 6 weeks after with the Gadolinium. I am not in a flare now, I feel this will be a waste of time and now after reading what you have said about MRI ruling out MS etc. I am now wondering what an earth is wrong with me then.

So can MRI detect TM or is TM diagnosed by MRI only. I have LP scheduled for few weeks time, bloodwork and yet again another MRI. Wishing for some ideas and answers.

[Nancy T]

Thanks much for the info, Dr. Kantor.

(And say, your biography is impressive--degrees in literary theory, engineering, and medicine--there are still Renaissance men out there!)

[Dr. Daniel Kantor, MD]

I agree -- very good point, especially now with the newer MRIs (i.e. 3 Tesla) and with serial negative MRIs, it would be unlikely.

In some studies  negative MRI and negative LP means that MS is almost entirely not possible.

See:

Soderstrom M, Ya-Ping J, Hillert J, et al. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998;50:708-714

[Dr. Daniel Kantor, MD]

I agree -- very good point, especially now with the newer MRIs (i.e. 3 Tesla) and with serial negative MRIs, it would be unlikely.

In some studies  negative MRI and negative LP means that MS is almost entirely not possible.

See:

Soderstrom M, Ya-Ping J, Hillert J, et al. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998;50:708-714

[Dr. Daniel Kantor, MD]

I agree -- very good point, especially now with the newer MRIs (i.e. 3 Tesla) and with serial negative MRIs, it would be unlikely.

In some studies  negative MRI and negative LP means that MS is almost entirely not possible.

See:

Soderstrom M, Ya-Ping J, Hillert J, et al. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998;50:708-714

[Dr. Daniel Kantor, MD]

I agree -- very good point, especially now with the newer MRIs (i.e. 3 Tesla) and with serial negative MRIs, it would be unlikely.

In some studies  negative MRI and negative LP means that MS is almost entirely not possible.

See:

Soderstrom M, Ya-Ping J, Hillert J, et al. Optic neuritis: prognosis for multiple sclerosis from MRI, CSF, and HLA findings. Neurology. 1998;50:708-714

[Nancy T]

It's never been clear to me whether that oft-cited figure of 5 percent of "clean/normal" MRI patients that have or eventually get MS includes scans that aren't totally "clean" but have (in, say, a person in their 30s or 40s) those famous "nonspecific" small spots that might be migraine, tiny strokes, etc. In other words, whether such MRIs fall in the "normal" category in the context of MS statistics or a possible MS patient. (Not that it really matters from a practical standpoint.)

[Dr. Daniel Kantor, MD]

Very very infrequently

[Expert Advice is awesome]

Hey Dr., one last quick question. What is the percentage of individuals who have a clean MRI but eventually develop MS, or how often do physicians see this happen?