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Diagnosed and confused

I was diagnosed with Relapse and remitting MS yesterday based on my clinical examination and my MRI results. However, i am still awaiting my LP results but he has diagnosed me before they’re back? He still wants to get the results but has already concluded that it will be positive and therefore diagnosed me already.

How can he diagnose me without them being back?

He says he will write to me with the results and if positive LP then he will refer me to the MS nurse with all the results and if negative maybe he will rethink but has said im diagnosing you with MS already though as you already meet the criteria without the LP?

My MRI showed lesions in my brain (periventricular) and spine (c3,c4,t5,t10) although small they are there, however the radiologist reported they are non specific but based on the clinical evidence demylination seems likely.

I don’t understand how he’s so sure when even the radiologist says they’re non specific.

Has anyone else been diagnosed without an LP?

Me and my family are just very confused why he’s diagnosed me without all the evidence being back. Does it matter that my leisons are nonspecific they are still able to diagnose?

Sorry if this all sounds jumbled i’m just very confused how he has diagnosed me but still wont refer me yet until my LP doubly confirm it…

My MRI scans brain and spine along with my symptoms were enough to diagnose me with RRMS. I am yet to have LP it hasn’t even been mentioned to me. I’m due to start my treatment for RRMS in 4 weeks!

Hello

A positive lumbar puncture isn’t necessary for an MS diagnosis. Only about 80 to 95% of people with MS have positive tests for Oligoclonal bands in their cerebrospinal fluid. Which means up to 20% of people with MS don’t have O bands in their CSF, ie false negatives.

Neurologists use the McDonald Criteria (nothing to do with burgers) to diagnose MS: https://www.mstrust.org.uk/a-z/mcdonald-criteria

If you have more than one demyelinating lesion, that shows dissemination in space, and have had more than one relapse, that shows dissemination in time. Neurologists can diagnose on the first relapse if there is evidence that some of the lesions are older than others (ie dissemination in time).

Neurologists also use your verbal history in their consideration of a diagnosis as well of course as the physical examination. There are specific reflex reactions that are typical of MS. Something to do with when they scratch the sole of your foot, if your toes go one way it means MS is likely, and the other way means not MS. (I’m quite sure there are loads of others, but I’m not a neurologist so I’m always in the dark when they’re prodding me with pins, mucking about with tuning forks and looking at what my eyes are doing!)

I suspect you may just have to put your faith in the doctor regardless of the LP results. And when you then ask why they do them, look again at the McDonald Criteria, sometimes, especially with Primary Progressive MS, an LP is needed to meet the criteria. I suspect in your case, the neuro didn’t need the LP.

Sue

Thank you both for taking the time to reply! This clears it up alot for me! Hopefully i’ll be started on treatment soon.

I was diagnosed with PPMS in October 2017 on the basis of neck and spine MRIs and physical examination only. No lumbar puncture.