Having a disagreement about dx

Can you be diagnosed with no lesions on your brain or spine, and just a posotive lumbar puncture ?

Thats the question , im having a debate with a woman who says you can as mri cant always pick up lesions , and a posotive lumbar is all you need .

Ive said this is not correct and she is wrong.

Thoughts please and there are plenty of experts on here lol .

Regards Iain .

From what I’ve read and I’m not an expert. There is no way in jiffin hell you will get close to a sniff of an ms diagnosis without lesions. Clear MRI, shock horror…might just be because there are no lesions, just a thought!!!

Nope. +LP regardless, it’s lesions plus neuro exam = MS.

That’s all the maths I can do.

LP helps as does VEP, but ultimately it’s lesions and relapses or lesions + LP + deterioration.

The neurologist uses all the tests and comes up with a diagnosis.


Ive said the same but according to her im talking tosh and thats being polite , as she should know as she has had a dx with posotive lumbar only .

Oh then her friend got involved and she should know as she too had been given a dx the same way .

I said as they were both from the good old USA maybe as they were paying for treatment that might explain it.

I have never ever heard off this and believe me ive spoken to plenty of people about it today .

Regards Iain .

I’m no expert but I had a quick look at the McDonald criteria, and all of them involve lesions. Anjo

I told her about the Mcdonalds criteria and believe it or not they dont believe in it as its old and not followed anymore .

I gave up and walked away , and thats why the Americans have to pay for medical help lol .

Ppms can be without lesions…

She says its rrms , and how do you not need lesions on either your brain or spine , to come to a dx of ppms , sorry im now curious to know .

I’m not sure that it’s a “criteria” thing, but sometimes it isn’t that black and white. As ppms isn’t as inflammatory as rms, you are less likely to have lesions as there aren’t major focal patches of inflammatory activity (a lesion is the radiographic marker of relapse really) . In ppms you are also more likely to have heavy cord disease, and the cord is harder to visualise on MRI and therefore lesions sometimes don’t show on the scan. There will be atrophic change on the scan though… there should be a positive lumbar puncture, normally visible disability and some poor person who has been through the mill attached to it.

TBH, if you smell BS you are probably right. I always try to be open minded when it comes to people’s suffering, as even if it’s not ms they are in pain somehow. The only problem is that It can irk a bit. When the reality of diagnosis is multiple mris, X-rays, emgs, needles in unthinkable places, countless hospital appointments, years of anxiety - Each test positive, chipping away at whatever hope you have left. I remember a mate once telling me they had “all the tests for ms”, eager to find out their experience I grilled them on it… reality was they’d had an neurological assessment by there gp, but a blood test found b12 deficiency, she had a jab and it was sorted in a week - so much for my empathetic friend.