Question about MRIs and lesions

[Sue31961]

I (think) I know that you have to have 2 lesions that appear at 2 different times, right?  Do the lesions have to be in 2 different locations (i.e. brain & cervical area or whatever), or can it be in the same location (both being cervical or whatever)??  Do you also need a positive spinal tap??

I go for another MRI of my brain and spine at the end of June, so I was wondering.

Thank you!

[Sue31961]

Is there already an easier MC here somewhere??  Where??

Thanks!  :)

[jensequitur]

Yup, but I'm still not getting it - not your fault!  Nowadays it takes me three or four reads to understand anything that isn't fiction.

[Sue31961]

I think it was 3-4 years ago that they say the 2 lesions on my spinal cord. I didn't have any of my brain.   I hadn't been back to the Neur. until recently.  They do suspect it's MS.  The other things have been ruled out.  Back then, they did a spinal tap and it was negative.  I go for another MRI of my brain and spine at the end of this month.  It was scheduled to just be without contrast (trying to save a tiny bit of money I guess!).  I called the Neur..  Now they are going to do the MRI with and without contrast.  How long do you think that MRI will be?  The doctor also wants to do another spinal tap.  I told him I wanted to wait to get the results of the MRI first.  I go to the VA for care.  It's residents that do the spinal taps.  They keep hitting my nerves, while trying to numb me up.  They did do the spinal itself under Flouroscopy.  I wish they did the numbing with it too!!!

Thank you for your help!

I look forward to your more understandable version of the MC.

Sue

[Quixotic1]

Have you read my current version on the MC?  We bump it up periodically, but I haven't submitted it for a Health Page yet.

Quix

[jensequitur]

Cool - I know your version will be a lot easier to understand!

[Quixotic1]

I intend to try to write a distilled version without all the editorializing and including charts.  It will still be difficult, but maybe less so.

Quix

[jensequitur]

To be honest, I've looked at it several times, and it still is hard to understand.  My cog fog is better than it was last year, and the language itself is not for laymen.  However, it's all we really have to go on!

[Quixotic1]

Hi, Don't feel bad that you don't understand the nuances of the McD. Criteria.  It took me a lot of reading to get it all straight, and I had to wait each time I worked on it until my mind was clear(er).

About the two lesions in the "same place."  That means literally "in the exact same place."  So, both lesions could be in the cervical area and still be different as long as they weren't the same lesion in the exact same place.

If you have slowly progressive symptoms that really never improve, though they may be stable at some times, then you may be looking at a Primary Progressive course.  This is one of the hardest situations to diagnose.  Because there is no good history of attack which gets better.  Even if only some of the symptoms get better, it looks like many other progressive neurologic diseases.  So, they have to watch you for progressive disability over time.  The minimum length of time is 1 year for the Criteria.  

It is not uncommon for PPMS to have more spinal disease than others.  Also, brain atrophy is seen earlier in PPMS.  And, because PPMS may not have as much inflammatory stuff going on, the spinal tap is more likely to be negative.

You should be having complete neuro exams every year and complete MRIs (brain and spinal cord) every year.  Along with that they should have done a thorough workup to exclude other diseases.  Where are you in that process?

The doctors may often feel little rush to come up with a diagnosis of PPMS.  For one thing, there is no good treatment for it as of now.  So, without any treatment, why rush to make the diagnosis?  This is okay as long as they are continuing to look for others things that it might be.

The worst problems in PPMS are more motor than sensory.  The classic picture is progressive weakness of the legs along with spasticity.  Of, course other things can accompany it, such as weakness/spasticity in the arms and hands or back.  And, there can be any sensory thing happening also.

Does this help at all?

Quix

[Sue31961]

I'm having trouble understanding that.  Do you understand it?  I have a lot of cognitive problems.  I need things very easy to understand, especially these days.  

What does it mean if you're not sure about attacks.  I've continued to have more and more symptoms over the last 5 years.  I haven't really felt better at all.  I've had contiuous and new symptoms over that period of time and 3 years ago they saw a couple lesions on my cervical spine.

[jensequitur]

Check out the Health Page on McDonald criteria - it will help explain what the doctors are looking at.