How big does a lesion have to be?

I was wondering because I have read on here that it depends on the size and location of the lesion whether it is related to MS. Can someone please clarify for me what the size should be and where they should be located? Maybe this is why my neuro still says there isn't enough evidence.

my mri reads this

periventricular preponderance with foci measuring to am maximum of 5 mm

4mm hyperintense T2 focus in the posterior cord at the C1 level

I don't want to write everything down because I have already done that in an earlier post. I am just wondering if these are big enough and in the right locations or if this is the reason that my neuro is still questioning it.

Oh and I have 1 Oband in my csf none in my serum and my IgG index is elevated.

Thank you

Paula

[figuerpa]

sorry just noticed it say this also

bilateral supratentorial nonspecific hyperintense T2 and FLAI signal with white matter foci, the largets just over 5mm abutting from the left frontal horn. Other foci measure on the  order of 3mm or less

[Quixotic1]

Paula - Would you please review your symptoms and abnormalities on exam?

That MRI is totally sufficient for a diagnosis if you have enough history and exam evidence (and if the mimics have been ruled out).

An MS lesion can vary from unvisible to HUGE.  Rule of thumb with a lot of neuros is that they won't "count" anything smaller than 3mm.  The really tiny lesions can look like small vessel disease.

I have to ask what your neuro is expecting to see.....neon red lesions spelling out MS?  With that MRI I don't see the need to have done the LP!

I know where you can rent a cattle prod.

quix

[figuerpa]

Thanks Quix,

My symptoms are

Left leg, arm and face - numbness, tingling, buring and pain
unrinary incontenence
bowel incontenence
loss of words
lack of concentration
confusion
slow response
little to no reflexes in left leg
fatigue
vertigo
l'hermittes
heat sensitivity
twitching

I do have lesions in my spine and head, LP came back with 1 Oband in csf, elevated IgG index. I think this is enough to diagnose but he is still saying with the single O band that it is a negative result.

I am waiting to hear from another neuro that Slightlybroken suggested to me to see what he has to say but I haven't heard from him as of yet.

Just got the VER done and guess we'll see what those results are as far as what he does next.

Thank you,

Paula

[tonyad]

   Hello,

    An LP is not an actual Diagnostic Test!  Rather it can aide in a dx.  I actually went to an MS Seminar last night (learned a lot) and the MS Specialist (speaker) said that a lot of Neuro's as of today are not even doing LP's these days because they can not be used soley for dx. He also said that a "Good" Neuro knows that MS is mainly a Clinical dx but they do like to add an MRI in the equation just for a look - see.

     With that being said, have you showed any clinical signs (ones that he can visibly see) that are observable to your Neuro?  I hope you can get answers soon to clich your dx. If he is not willing to "Jump on Board" than I would take all medical records and tests and go visit a different Neuro.

     Hope I made sense :)

Take Care,
~Tonya

[figuerpa]

Tonya,

Thanks for your input. My nuero has been dilly dallying about giving me a dx of anything. He is finally running more and more tests so hopefully we will get to the bottom of this soon.

Paula

[michelleislay]

oh man,

it's so interesting to see what everyone has to say on this.  you really are being made to jump through hoops, aren't you?  yet i do know how willing you must be to do it--anything if it helps, right?

you have maintained such a great attitude through all of this paula!!  i'm in your court and know you will get some answers/help soon!!!

xo michelle

[figuerpa]

Michelle,

I am being made to jump through hoops but you know I have to look at it with a positive attitude and keep my hopes up or break down and cry my eyes out (which I have done on occasion ;) )

Hopefully this last test will be enough to show him that I am ill enough to dx. Not that I want MS but getting on the right meds are more likely to help me. ten more days till I see him so I will know more from there.

I don't think he really deals with MS alot, he is more of a stroke neuro. I just researched him a week or so ago and he has all kinds of rewards (loss the word, I know that isn't it but hopefully you get my drift) for strokes.


I am sure I didn't get the whole picture of what he does but that is all I found. So hopefully he will get off his a$$ and make a dx.

Anyway this wasn't suppose to be a rant lol

Thanks again

Paula

[Quixotic1]

Paula

YOUR NEURO IS A DUNDERHEAD!

IMO you should have been diagnosed long ago, if the work up to rule out mimics has been thorough.  You need a new set of eyes on all this (read that - NEW neuro)

Quix

[figuerpa]

Quix,

Thank you. I am in the process of getting a new neuro. My insurance doesn't give me many options as far as neuros go. But I am working on it.

Paula

[shermay]

Hi Paula,

I don’t know if the size of the lesions makes any difference, it’s just with my last MRI the tech told me that a particular lesion was larger than before – having said that I didn’t have contrast and was only on a 1T  machine, this time around I had contrast and was on a 3T – so maybe that made a difference – I don’t know.

When I was dx ‘officially’ 11 years ago, my Neuro said it was not necessary for me to have a LP, I did have a VER which came back negative though.

Get yourself off to another Neuro who can really help you through this, because it sounds IMO that you need another one, who will listen, and read your reports correctly.

I really find it amazing that these days, Neuro’s are so slow in dx MS .

I’m with Q on this one, when all other factors have been ruled out, and your Neuro will not give you a dx of at least SOMETHING, then it’s time to move on.


Love,

Debs xxxxxxxx