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Lumbar Puncture

Hi again everyone hope you all keeping well.

I have a question about excluding Ms definitively with lumbar puncture. As some of you know from my recent reports that i had a lumbar puncture done and the results for O bands was negative.

My first neuro whom i do not have much faith in organised Mri of brain and lumbar puncture plus various blood tests. He wrote some confusing stuff on his letter regarding my Mri, saying Mri shows scattered T2 hyperintensities in both cerebral hemispheres. There was a slight increase in these compared to her previous Mri scan.

He then goes on to say. There are no enhancing lesions, now i'm confused here because i did not have contrast, and my impression is enhancing lesions are seen with contrast. Am i wrong here?

So he then wrote he has a low end suspicion for Ms and felt it would be important to try and exclude it definitively by organising a lumber puncture. He also wrote that my ESR was normal, but the copy of the results i got said my ESR was high.

I have since had my ANA,ESR, CRP,and Anti double stranded DNA anti body blood tests done which my new neuro requsted. All negative.

I feel like my first neuro was careless in his assessment of me.

Thanks for reading.
Lorraine.
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5112396 tn?1378017983
A lumbar puncture will not rule MS in or out definitively. Many people are diagnosed without having had one, or indeed having had one with negative results (no unique o-bands).

Was this report actually written by your neurologist or the radiologist? Typically the actual MRI report is simply a radiologist stating what they see in the context of what the MRI was ordered for. This is usually someone you never meet. The neurologist then takes these Cliff's Notes (whilst hopefully looking at the images themselves as well) and considers them in conjunction with your lab results, clinical exams, and history and proceeds from there with either a diagnosis, looking at alternate possibilites, or wait-and-see.

I would certainly bring it up if I saw 'no enhancement' if in fact no contrast agent was administered. You have MRI proof of increased hyperintensities over time, as per the report. I might consider getting copies of my MRIs and looking for a second opinion.
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Avatar universal
Thank you for your reply.

Yes the neurologist himself wrote this letter about scattered hyperintensities and no enhancing lesions, when i didn't in fact have contrast at all. That's why i was wondering he wrote that when he knew i did not have contrast.

As i said in my other posts, i have gone to a new neurologist who is going to do a cervical spine Mri in January followed by a Brain Mri with contrast in February. He will then see me in March. Everything is a bit up in the air at the moment for me.

All my new neuro said to me was that he was not convinced it was Ms.And that a very close eye needs to kept on me and that my prognosis was good.Yet in his letter to my Gp, he says i do not meet the diagnostic criteria for Ms, and that lots of other things can cause the hyperintensities.

To be honest i don't know what is wrong with me but something is definitely up, i hope to get some answers soon. I have all Mri reports and letters  
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Avatar universal
Thank you for your reply.

Yes the neurologist himself wrote this letter about scattered hyperintensities and no enhancing lesions, when i didn't in fact have contrast at all. That's why i was wondering he wrote that when he knew i did not have contrast.

As i said in my other posts, i have gone to a new neurologist who is going to do a cervical spine Mri in January followed by a Brain Mri with contrast in February. He will then see me in March. Everything is a bit up in the air at the moment for me.

All my new neuro said to me was that he was not convinced it was Ms.And that a very close eye needs to kept on me and that my prognosis was good.Yet in his letter to my Gp, he says i do not meet the diagnostic criteria for Ms, and that lots of other things can cause the hyperintensities.

To be honest i don't know what is wrong with me but something is definitely up, i hope to get some answers soon. I have all Mri reports and letters to my Gp from both neuros. I intend to get all my mri discs which i had done over the years, have some need to get the rest.My Gp is outstanding and understands my frustration and determination to figure out what is going on with me.

I will keep ploughing ahead. Thanks for your replies and hope you are well.

Lorraine.
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Avatar universal
Hi again, just a quick question. Do you think Ms is a likely cause of these changes happening on Mri and the symptoms i am currently having?

The last couple of days have been quite bad with severe cramps in my legs with fluid accumulating in my ankles. My Gp gave me fluid tablets and they are working with the pain and swelling, but i still loose my balance on and off.
It's like i am struggling to walk properly at times.

I must refer also to my first neuros letter when he was discussing my Mri. He never mentioned the lesion in the corpus callosum which was picked up on Mri, would that not be a significant finding in your opinion?

Really appreciate your help.Hope you are well.

Thanks
Lorraine.
Helpful - 0
5112396 tn?1378017983
I can't really speak to what might be causing your MRI findings or symptoms. I can say that as a neurological disease, MS would not be the cause of your ankle oedema. And typically, limbs are effected on one side of the body at a time (unilateral, versus bilateral symptoms). However, with MS there are always exceptions.

Also, I should apologise for not reviewing your other posts in the community before I responded. I mentioned things above that you already took the time to cover!

You stated the neurologist wrote "The white matter changes on MRI are non specific and may be seen in smokers, migraine, connective tissue disorders or demylenating disease for example." and "I have explained to her that she does not meet diagnostic criteria for MS and i have no structural evidence of other neurologic  disease."

At the moment, you have a collection of inconclusive results, so this leaves you with a couple of options; wait and monitor, or find an MS specialist or new neurologist.

Do you have any upcoming appointments with your doctor wherein you can discuss your concerns or ask for more information on your test results?  There's only so much us non-professionals can add, though of course, a lot of us can empathise with the drawn-out process of getting to the bottom of health issues and the stresses and strains that can cause.
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Avatar universal
Again thank you for your replies and no problem with my previous posts, i understand.

Yes i have been to my Gp with all the questions related to my test results.The problem is that i have been to see someone for a second opinion and it is this new neuro who wrote the above which you have highlighted in your reply to me.

My first neurologist is the one who wrote about T2 hyperintensities and no enhancing lesion, that's why i asked about contrast. Now this new neuro has arranged for me to have contrast and all the bloodwork which has come back negative.

My main concern right now is getting to the bottom of whats causing my symptoms. If one neuro is saying no enhancing lesion and no contrast was given, how can that be, questions which in due course i will ask of him.The new neuro is said to me when i went to see him, after which he gave me a through neurological check, and when he looked at my Mri discs, he said he was not convinced it was Ms, which is where i'm at right now waiting for the upcoming 2 Mri's.

Yet in my new neurologists letter to my gp he said i do not meet diagnostic criteria for Ms, so it's all frustrating for me. I may have to see an Ms specialist if this new neuro can't say it is Ms, when it seems to be pointing big time in that direction.

The corpus callosum lesion identified is in the radiologisit's report, but strange that neither of the neurologists mentioned it in their letters  concerning my Mri results. that's suspicious to me because from what i've dug up over the net about lesion in the corpus callosum,most of the information says they are found in a lot of Ms sufferers.

Juxacortical is also discussed as being another area where Ms plaques are seen, the new neuro says in his letter juxacortical hyperintensities, while the first neuro said Hyperintensitirs in both cerebral hemispheres, don't know if cerebral hemispheres and juxacortical mean the same?

I'm really sorry for the long post, but i hope i have explained it o.k for you as it is all so confusing to begin with, and thank you really for your replies.It helps when someone who is an Ms sufferer gives their point of view on some of the difficulties surrounding the diagnosis of Ms.

Thank You
Lorraine.
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