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Is lumber puncture necessary before MRI result?

Hi all,

Just a bit of advice and hand-holding needed really!

I had a clear mri in november (brian only-no contrast), and saw the neurologist at the end of December. I was referred for the mri by an opthalmologist. I had a full neuro exam, which only showed up a couple of problems, left side sensory stuff, babinski’s in left foot, right eye blind spot. He told me he wanted to do a full spine and brain with contrast, and a LP. I’ve got an appointment for the scan at the beginning of Feb, and just got a date for the LP the week before. Apart from being scared witless because it all seems to be happening very fast (judging by some peoples timeframes on here), I’m wondering if its necessary to have the LP first, or at all? Wouldn’t the mri with contrast show up if there is anything going on? Or do they need the LP for diagnosis? I admit, I don’t like the idea of having it done, I have lower back problems, suffer severe migraine, and had a nasty reaction to an epidural some years ago.

If I decline it, will I 1) put the neuro’s back up, 2) hinder any diagnosis, positive or negative?

Any help/advice greatly appreciated

Hunny xx

Hi Hunny,

Although LP seems to be routinely ordered, on the NHS, as part of an MS investigation, it’s not strictly necessary for diagnosis, no, and I have been diagnosed without one, because I refused.

It may have made a difference that I was being investigated privately, so as I was not only a patient, but a paying customer, I may have had a bit more personal input to decisions than is typical on the NHS.

I’m not criticising the NHS, but there seems to be a culture of: “You need a lumbar puncture because we always do it like this”, instead of taking the specific needs and views of the patient into account, and considering what other evidence is available that could support a firm diagnosis.

My neuro would have preferred me to have a LP, but did not insist on it, and in the end, I had pretty classic signs on MRI anyway, so he felt confident in making the diagnosis on that and symptom history alone.

So basically, you do not have to have it. They probably won’t like it if you object, and it may take longer to reach a firm diagnosis. But if you’re positive you don’t want it, that is your absolute right, and nobody should be attempting to persuade you there’s no other route to diagnosis.

Tina

Things aren’t actually moving all that fast, so don’t worry about that. Referrals from other consultants can often be quicker than GP referrals and it’s normal procedure for a neuro to send the patient for tests at the first appointment. How long it takes to get the appointments depends on where you are and how lucky you are with cancellations etc. For example, my local MRI unit can usually see people within 3-4 weeks, but it can be quicker if they have a cancellation. The process slows down when the results are negative - that tends to be when people get stuck in limbo - because they get discharged or are put on a routine follow up of a year or even more.

So having positive results is the route to a quicker diagnosis. Therefore, I would say that (usually) the only time an LP isn’t necessary is if you have the required number of lesions visible on MRI (or are prepared to wait until you do).

You’ve already had a negative brain scan. The chances of this new brain scan showing lesions is therefore quite small unless you have had new symptoms since then (the contrast helps to show up newly forming lesions that can be missed on non-contrast MRI) or unless the scan that was done before was not the right protocol for MS.

The spinal scan is obviously an unknown quantity - it may or may not be positive.

An LP is not essential, but having one can greatly speed up time to diagnosis: if it is positive, you are very much more likely to get a diagnosis, even if you don’t have the required number of lesions visible on MRI. And, at the moment, it’s looking like you might not have very many lesions visible on MRI.

If you are really reluctant to have an LP, why not try and delay it until after the MRI results are in? Let the neuro know that you are worried about the LP (cite the epidural and the lower back problems) and although you are not refusing one, you’d rather wait and see what the MRI results are first. And ask if this is OK.

Karen x

Thanks to both of you.

I have just rung the neurologists secretary and asked if I can postpone it untill after the MRI results were in, and they were fine about it, told me to ring two weeks after the scan when they should be able to give me an idea of what’s going on there, if anything. The only things that showed up on the first mri was ‘some inflamation of the optic nerve’ and my cyst, (which has been there 10 years), but no lesions. Here’s hoping it stays that way!

Thanks again xx

Good result

Fingers crossed for you that you can avoid it!

Kx

I was diagnossed without a lumber puncture, MRI results only.

I did have a lumber punture previously (20 years before diagnossis) and had a severe reaction to that which took 3 weeks to go so I would defintly not have 2 weeks before MRI is due

Good luck with both

S

I’m turning down an L.P. I have a huge phobia of needles and I do not accept the potential side effects. I know it’s rare to have a serious issue after the procedure but I don’t accept the fact it could happen. I know it’ll take me longer to get a diagnosis but I figured if the L.P showed something it won’t be able to give a definite answer what it actually is. If it comes back clear then I still have no answers. I was losing sleep when I was told that an L.P is done but I’ve decided I will just turn it down so I don’t have to worry about it.

Hi I was diagnosed with a mri with no contrast, symptoms and my previous medical history only, I did not have a LP, However my mri did look like lights on a christmas tree LOL. Also i was diagnosed within a couple of weeks x

Hi all I was diagnosed without an MRI but with an LP, EPs, clinical exam and symptoms (I am very claustrophobic) but the MS specialist did not seem to find it necessary and I did have an inconclusive CT scan as well. The other tests were positive btw. Teresa xx

Thanks everyone for your replies, I guess I’ll wait and see what the mri comes up with and make a decision then xx