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McDonald Criteria - lesions but no symptoms

I originally posted this in a different thread, but Quix wanted me to move it since there is now another "newbie" posting who is in a similar situation.

I wanted to thank you for doing all of this work on the criteria. I really appreciate how you broke it down. I have been doing alot of reading in the last few weeks since my Neuro gave me a "probable MS" diagnosis.

I still have a question..... Can you be diagnosed with MS with lesions, but no real major symptoms, a normal LP, VEP and Bloodwork?

I didn't present with clinical symptoms, but instead had numerous lesions on my first MRI, and then showed more lesions on my 2nd MRI at the 6 month mark. It was all by accident that this was discovered. My only symptoms so far have been dizziness of and on for the last year and the Nuero noticed a slight left hand tremor on exam. I can't really establish a patterns on the symptoms coming and going yet. My LP, VEP, EEG, and bloodwork have all been normal. My Neuro is reluctant to officially diagnose MS because of the lack of clinical symptoms. If I read the criteria right, you really need the clinical presentation for a diagnosis. Is this correct?  What about those of us that are "atypical" and don't neccessarily have symptoms that have shown as "attacks"?

I feel like with all of the reading I have been doing lately to get up to speed, that I should have just gone to medical school years ago. )

My Neuro's office called today with my schedule.  They have me doing another MRI in 4 weeks, with an appointment with him a few days later.  That will make my 3rd MRI in 8 months. Yippie!

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Hi Amy,

I think I am in a situation very similar to yours.

At this time the neuro gave me a "highly probable MS".

To make my story short back in January I went to my doctor for stomach problems and mention to her about this little tingling I had in my right leg that really was no big deal to me.  I never ever imaging that this little tingling would bring me to the devastating news of MS.  Initialy I had a lumbar MRI to check for a disk problem than I had a EMG to check for nerve problem in my leg.  Finally I had the brain MRI which revealed 13 white matter lesions 2 of them being classic MS lesions (one is ovoid the other is juxtacortical)  .  A week later I had the c-spine and t-spine MRI, they came back negative.  The following week I had the visual evoked potentials, it came back negative and a spinal tap and blood work both negative for MS or other disease that mimics MS.
At this point I'm waiting for the second MRI in September.  My neuro made it clear to me that if I have one new lesion on that MRI I will be diagnose with MS.  I think that to this point she has been following the McDonald criteria to the letter and she's looking for dessemination in time.

Like you I never had an attack but I will be diagnose regardless if my MRI shows at least one new lesion.

Have you ever had a spine MRI?  
Do you know if the lesions in your brain are characteristic for MS?

Hope this help


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Avatar universal
Thanks for responding. I have only had two brain MRI's and yes my lesions are a "classic MS" according to my neuro. I know he has thrown around "periventricular", but honestly everything since last September when this all started is a bit of blur.

At my last appointment, I asked my neuro about having a t and c spine MRI too when I got back for a brain MRI in early june. He said that since I had changes from the first to second brain mri, that he didn;t think the spinal mri's would be neccessary for diagnosis.  I didn't really argue with him, but I still might.  He said that since I have negative test results otherwise and no major symptoms, that he is really just looking for more evidence on a third MRI to clinch things. He sent me to an MS specialist who promptly dismissed me because of the negative LP and lack of symptoms. I then went back to see my regular neuro who was visibly in disagreement with the specialist and wasn't willing to let this go more than another month before I go back for another MRI.

I don't think that the radiologist counted my lesions, but it was enough to elicit an alarmed response from my PCP and then the neuro. I do know that on the 2nd MRI at 6months, the radiologist noted at least 3 new lesions with enlargement of some of the older ones.

It has been a whirlwind tour so far, and I am looking forward to getting diagnosed with something, because limboland is making me a bit crazy.

It is nice to be able to talk to others who have been through this, or are going through it now. We all have to help each other hang in there.  :)

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