Can You Can Have MS without MRI Lesions?

[Quixotic1]

I know we have covered this before, and I really should spend more time on the National MS Society site, but this is a quote from the NMSS Sourcebook on MRI's.  It says everything so much more succinctly than I do when I'm "winging it."

"Diagnosis
Because MRI is particularly useful in detecting central nervous system demyelination, it is a powerful tool in helping to establish the diagnosis of MS. It should be remembered, however, that approximately 5% of patients with clinically definite MS do not show lesions on MRI, and the absence of demyelination on MRI does not rule out MS. Also, since many lesions seen on MRI may be in so-called "silent" areas of the brain, it is not always possible to make a specific correlation between what is seen on the MRI scan and the patient's clinical signs and symptoms. In addition, with advancing age (probably over age 50), there are often small areas seen on MRI in healthy people that resemble MS but are actually related to the aging process, and are of no clinical significance."

http://www.nationalmssociety.org/site/PageServer?pagename=HOM_LIB_sourcebook_mri

Guys, not to restate the obvious but this is 1 out of every 20!!!  I'll keep looking, but even my MS Neuro, whom I consider very smart, felt that MS was ruled out by normal MRI's.  I need to understand whether the 5% got diagnosed because they presented so classically - maybe with Optic Neuritis, more than one clear attack, a very positive LP, and a tatoo on their forehead that says, "I have MS!"

Quix

[KF4ZNL]

My wife was diagnosed in 2005 her doctor died in 07. the records are nowhere to be found.  Here's our problem, she had a major exasperation in August and could not walk unassisted so I took her to Piedmont Hospital in Atlanta. The MS doctor on call ( he has a MS Center a couple of miles away)  gave her five days of Solu-Medrol treatments and her vision got better then was transferred  to Shepherd MS clinic next door after 20 days of rehabilitation she is now in a power wheelchair.   When we went back for a follow up it seemed like the director of the ms clinic at Shepherd  dismissed her saying he could not say it was ms related because her mri showed no lesions.

[Twilight823]

Who was your neuro?   My MRI only shows two small white spots and no lesions on the spine.  Yet I have burning leg pain, Right eye pain all the time at a level 4-5 and sporadic rib pain that sends me into tears.  I need to see someone that understands this and not just want the typical symptoms to make their job easier.

[immisceo]

It doesn't sound like MS would be the most likely candidate for what you're going through, and I'm so sorry you haven't found relief in the medications you're on.

Did your doctor speak with you about your cervical spine issues and if the sensations you're experiencing are characteristic of those protrusions? Have you seen a rheumatologist? (as you mention a lot of joint pain and a firbo diagnosis in the past). I'm thinking shingles could account for the polyneuropathy, perhaps.

If you start a new thread of your own you may get a little more response. This thread is kind of a 'golden oldie' and people may skip over it as they look on the front page of the forum, not realising there's a concerned new member asking questions.

[MelSel3]

Hi, I am 43 and have very similar problems.  tingling and burning in arms legs, right side of face and my scalp.  Cannot distinguish the difference in hot and cold water.  But I also have joint pain in hips, wrists and elbows.  I have a burning tongue also.  I have seen two neuros, rheumatologist, switched gps.  I'm so tired of this.  I had a nerve conduction study and they said I have polyneurophathy and mri showed protusion of c5-c6, and c6-c7.  I have been told in the past I have fibro and I take Cymbalta and Lyrica but obviously that isn't helping because I have been on them for over 4 years.  I have had shingles and have b-12 deficiency but shots didn't help that either.  Could I have ms or lupus?  I do not have lesions on the brain.

[skinner916]

im 34 years old me and my wife have been batteling this for 2 years now i have gone threw all the test this makes my secound time i have to walk on crutches now im used to doing things my self now i have to ask for help drives me crazy but i have to do it now im use to it they said ill be in a chair in a year my family keeps me going ill prove them wrong .

[kwarendorf]

Hi YA-

Welcome to our little chat. CCSVI is indeed a much discussed topic in MS Land. More and more research is being done in this area. It does seem as those most of the findings can't establish a link between CCSVI and MS. Here is a summary of an article published earlier this month.

Kyle

Mult Scler. 2013 Jul 4. [Epub ahead of print]
Chronic cerebrospinal venous insufficiency: masked multimodal imaging assessment.
Brod SA, Kramer LA, Cohen AM, Barreto AD, Bui TT, Jemelka JR, Ton K, Lindsey JW, Nelson F, Narayana PA, Wolinsky JS.
Source
Department of Neurology, University of Texas Health Science Center at Houston, USA.

Abstract
BACKGROUND:
Chronic cerebrospinal venous insufficiency (CCSVI) was implicated in the pathophysiology of multiple sclerosis (MS).

OBJECTIVE:
We evaluated neurosonography (NS), magnetic resonance venography (MRV), and transluminal venography (TLV) in subsets of MS patients drawn from a single-center, prospective, case-control study of 206 MS and 70 non-MS volunteers.

METHODS:
As previously reported, findings on high-resolution B-mode NS imaging with color and spectral Doppler of the extracranial and intracranial venous drainage consistent with CCSVI were similar among MS and non-MS volunteers (3.88% vs 7.14%; p = 0.266). Ninety-nine MS participants consented to intravascular contrast-enhanced 3D MRV to assess their major systemic and intracranial venous circulation, and 40 advanced to TLV that included pressure measurements of the superior vena cava, internal jugular, brachiocephalic, and azygous veins.

RESULTS:
NS findings and MRV patterns were discrepant for 26/98 evaluable subjects, including four with abnormal findings on NS that had normal venous anatomy by MRV. In no instance were TLV pressure gradients indicative of clinically significant functional stenosis encountered. The three imaging approaches provided generally consistent data with discrepancies referable to inherent technique properties.

CONCLUSIONS:
Our findings lend no support for altered venous outflow dynamics as common among MS patients, nor do they likely contribute to the disease process.