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Positive lumbar puncture

Hello lovely people,

Can anyone help with the diagnostic criteria?

I have the following:

Positive lumbar puncture for oligoclonal bands, positive VEP, three clinical relapses and bladder damage.

However, clear MRI.

I’ve looked at the McDonald criteria and I’m getting the impression that a diagnosis can be made without mri still.

Is this right? They literally have all the evidence of dissemination in time, relapses and lab results. Everything else and I mean everything else has been ruled out. Are they able to diagnose now?

Thanks in advance.

Hello Kate

I don’t think you can be diagnosed with a completely clear MRI. There’s no evidence of dissemination in space without MRI.

But, have you had your brain and entire spine MRI’d?

If you’ve just had a brain MRI, then there could be lesions on your spine. But if you’ve had the works, I don’t know what the answer is.

What does your neurologist say? How does s/he explain the LP, VEP and clear MRI, given your relapses?

This is what the MS Trust say about the McDonald Criteria: https://www.mstrust.org.uk/a-z/mcdonald-criteria

Sue

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Hi sue,

Thanks so much for your reply.

That’s what I mean, the MacDonald criteria states that dissemination in time can be either mri or lumbar puncture. So that’s why I’m confused.

She’s a normal Neuro and didn’t believe it was ms until she ran all the tests, as she’d done a brain MRI the year before and that was clear. But she did run full brain and spine this time. Clear. But then it’s only a 1.5T. So who knows.

I haven’t actually been back to see her after the lumbar results, she wrote me a letter (i didn’t book an appointment for the results as I thought it would be clear) and wants to refer me to an MS specialist. So he might be able to take a fresh look at my MRI’s.

I’ve just got to wait to see what the MS Neuro says haven’t I…

the ms specialist is the person who can really help.

good luck and i hope you don’t have to wait too long.

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"Because MRI is particularly useful in detecting central nervous system demyelination, it is a powerful tool in helping to establish the diagnosis of MS.

However, approximately 5 percent of people with clinically-definite MS do not initially show lesions on MRI at the time of diagnosis. If repeat MRIs continue to show no lesions, the diagnosis of MS should be questioned."

from

https://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI

This would indicate that a small number of people are diagnosed without definitive MRI lesions - on the basis of other indicative test results as you describe.

I understand that areas of MS inflammation in the brain can sometimes resolve, ie they don’t always leave a permanently detectable lesion or scar visible on MRI. It will be interesting to hear the specialist’s interpretation of your results and whether they feel there is enough evidence to start a DMD or not. Sorry this means more waiting for you, though, it’s not easy.

best wishes

Thank you Harebell.

Yes, it’ll be an interesting conversation with him. I shall post an update when see him.

Of course, I had to be the small percentage of atypical patients, my life! :wink:

Thanks for taking the time to reply to me. X