Test for MS

When going to a neurologist are they suppost to do a lumbar MRI and a spinal tap even though the MRI is normal? My neurologist  never  suggest any of them.I read in here about normal MRI and  wht i read you can even have MS even if MRI is normal am i right? Only test i did was blood work, nerve test , EEG and brain MRI.

[Udkas]

Hi Cheryl,
I would suggest you go to the health pages on this forum and have a read about MRI scans and diagnosing MS.

Yes you can have a normal MRI and still can't discount out MS because sometimes MS is not that simple to diagnose.  It is sometimes about the strength of the MRI machine, the timing when the MRI was done and many other factors. The diagnosis of MS is made on neurological findings, supported by MRI etc. but sometimes you need to have further attacks in order for the Dr to reach a diagnosis.

Most doctors when testing usually do a spinal tap (but this also can test normal), so is also not used alone to diagnose MS.  Many people with MS still have normal spinal tap.

If the doctor suspects lesions in your spinal cord he will order a cervical and thoracic spine MRI.  Some doctors again MRI the lot all at once but I guess this would depend on your symptoms and their findings.  

The health pages attached to this site will answer most of your questions.
Don't be afraid to ask your doctor questions either, it's your health and right to ask why and what they are doing.

Best wishes,
Udkas.

[wonko]

I have no official answer, but what happened with me is that first a brain MRI was ordered.  It was somewhat abnormal, so I then also had a c-spine MRI and LP, both of which were normal.  I never had a t-spine MRI or evoked potentials.

From my experience and what I've read, it often seems the brain MRI is the 1st test if MS is suspected.  If that is all clear, it seems many doctors are hesitant to order more tests.  I'm not agreeing with that, just stating I've often read that chain of events in forum testimonials.  

EMG/nerve conduction studies and thorough blood work and standard and should also be done to rule out other conditions.  

[wonko]

also, it may depend on where/what symptoms you have.  Some symptoms are suggestive of lesions in a particular place.  Like problems walking may me more reason to do a full spinal MRI than visual problems.  

Good luck.

[Heather3418]

Hi Cheryl,

In my case, the spinal MRI was done first, with the suspicion being MS or a spinal cord tumor.  Most of my symptoms at first where pointing to the spine.  After a lesion was found in the thoracic spine and demeylination suggested by the radiologist, a Brain MRI was done.  It was there they they confirmed 5-6 lesions which enhanced with the dye, just as the spinal cord.  It was obvious to the Neuro that I was indeed having an MS attack.

It was many years later, when my diagnosis of MS came into question by another Neuro, that a spinal tap was done, where it was found that I had 0-bands.  So the diagnosis of MS that I was given, then had taken away, was then re-confirmed.  Most Neuro's will not do a spinal tap unless there is eveidence already that it will turn out positive.  This is usually determined from the physical exam and they go from there.

It's important that all other causes of your Neurological symptoms be ruled out before MS is ever considered.  There are so many mimic's which I discuss at length in the Health Pages.

The diagnosis of MS can be a hard diagnosis to come upon.  Sometimes it can be early as in my case, then only to have it doubted by another Neuro, then once again go through ALL the testing to prove once again, that it is indeed MS.

Cear, distinct, relapses and remissions and abnormalities on physical exam, is what starts a Neuro to look for a diagnosis of MS or some of the mimics.  Then they depend on the brain and spinal MRI, then usually will follow that up with the invasive procedure, the spinal tap.  Usually in that order.  Others may claim that their Neuro's did things differently and that would NOT be incorrect.  I have yet to find any Neurologist to be on the "same page" when it comes to diagnosing MS.

I hope that you will continue to ask questions and read through the Health Pages.  There is SO much information contained there, that is literally invaluable.  Articles written by those who suffer from MS and have been through the sometimes long process of diagnosis.  

Big Forum Hugs and Best Wishes,
Heather - Earth Mother

[Heather3418]

And YES, you can have a diagnosis of MS without lesions.  It occurs in about 5% of people with definite MS.  It is thought that at some stage of the process, the MRI will finally show lesions.  The stronger MRI machine, the better, with and without contrast dye.  You can also have what they call mico-lesions, that cannot be detected by some of the weaker MIR machines, known as a 1.5 Tesla or less.  Most facility's have 3T now, which is showing more of what the 1.5T had missed.

[shoshin]

I just wanted to point out, in case you hadn't noticed in the health pages, that lumbar spine MRI's aren't done for MS because the lumbar area is outside of the central nervous system. It would make sense to have cervical and thoracic spine MRI's, especially if you have symptoms that could come from those areas.

Did your neuro look at the MRI images? Sometimes the radiologists make mistakes. I was dx'd with lesions in my cervical spine even though the radiologist said my brain was normal (the neuro said not, but apparently there aren't that many spots).

sho