Especially For Limbolanders age 50 and older

[MsWobbles]

Hi, Older Limbolanders (and all others)!

While researching at a local university medical library recently,  I have found some important information relevant to those in our age group seeking a formal MS diagnosis which I will summarize here.

First, what Quixotic1 suggested regarding the importance of obtaining spine MRIs (cervical and thoracic) is VERY important for us older Limbolanders.  I cite from the book "Magnetic Resonance In Multiple Sclerosis" the following:  "Because brain MRI is least specific over the age of 50 years, spinal MRI is proving diagnostically useful in this age group.  The presence of intrinsic cord lesions is strong supportive evidence for multiple sclerosis, as such abnormalities do not appear with normal aging in the way that brain lesions do."  In other words, when they
see lesions on your spinal MRI, they cannot explain them away as "normal aging, microvascular disease, small vessel disease" or any of the other buzzwords they are currently using to deny to older patients that their MRI brain lesions are, indeed, MS lesions.  Spinal MRI lesions cannot be age-related!

Regarding your brain MRIs, don't forget to have them checked for brain atrophy.  My initial radiologist never mentioned any brain atrophy on my brain MRI:  It took a radiologist at Mayo Clinic (reading the same film for an ALS inquiry) to point out the atrophy.  Several other radiologists have since said "brain atrophy."  However my most recent radiologist (a real dud) incorrectly said, "normal brain mass."  (He also failed to see my spinal lesions).

Why is brain atrophy an important, yet often overlooked, sign in the pursuit to find MS lesions?  According to the text "Multiple Sclerosis:  Current Status and Strategies For the Future" on page 39:  "Recent studies suggest that CNS atrophy may be the best neuroimaging correlate for clinical disability."  So that can help to validate the complaints of an undiagnosed person with major MS symptoms who has no conclusive lesions visible on brain MRI.  Just the fact that there is brain atrophy can help explain and substantiate the patient's symptomatic complaints, lending credibility that may help in the pursuit of an MS diagnosis.

So, for older Limbolanders seeking an MS diagnosis, it is very important to:
1.  Obtain cervical and thoracic MRI (preferably on 3Tesla, with and without Gadolineum).
2.  Assess for brain atrophy:  May need more than one opinion.

Now you have it:  There is, indeed, an age-related difference in the approach to MS diagnosis.
You know what you have to do.  Go for it!  Good luck to all of you!  

My wish is that, one day, there will no longer be a Limboland because there will be a simple blood test to accurately and immediately diagnose MS.  Or, better yet, because there will be no more MS!!

WAF

[MsWobbles]

John,

I don't think you'll get your diagnosis just based on brain or spinal cord atrophy, but it might help move you toward one.  You might also ask if your MD can see any "black holes" on the brain films which happen when lesions have been around for a while and just "eat up" the area, leaving a void.  I'm sure Quix could explain the phemonenon way better than I can.  Anyway, black holes mean you've had lots of lesions for a while.  So as you collect more of them, your brain shrinks (atrophies).

Remember, in the 0ver-50- age group, brain MRIs aren't as useful as spinal MRIs - cervical and thoracic.

Good luck to you!

WAF


P.S.  I can attest to the superiority of 3Tesla!  I could see my spinal lesions pretty well (even if the radiologist couldn't).  

[ozjohn]

Hi
well my neuro has not mentioned this either (surprise,surprise)
Seeing that I was 42 when I had my first MRI and just haad another MRI now that I am 57
I will take all my scans to my new neuro tomorrow and ask him if there is sign of atrophy
and hopefully I will be able to leave limboland after all these years (sigh)

John

[saveone]

WAF being 50 and undx I find your info very interesting.

I had a spinal MRI on  a1.5t.  It showed nothing.  That was maybe a year ago.  I would really like to have another on 3t.  I would be interested to see what it showed.

I intend to try to research your info but tonight I am too tired.

take care and live well

[MsWobbles]

My pleasure - glad to share.  We need each other's help here for sure with our neuros appearing to be essentially reluctant to admit older patients into the MS fold.

Please let me know what your contact finds - Hope it is the answer you seek!!

WAF

[Charley123]

Thanks for sharing this info.  My neuro's never mentioned brain atrophy.  I too hope that there will be no more MS in the future.  I'm about to send my MRI's to someone who runs several MRI centers and sounds like he knows what he is taking about.  Charley