Finding a dx.

[Shanberger]

When people talk about being diagnosed by MRI, is that of the brain only?

[euphoniaa]

When people talk about being diagnosed by MRI, is that of the brain only?

Hi Shanberger,

If the docs suspect MS, they should do MRIs of your brain and C-spine, both with and without contrast. It's also possible to have MS lesions in other areas of your spine, but they don't do MRIs of the lumbar and thoracic areas of the spine too often.

Even brain/c-spine lesions don't give a 100% diagnosis of MS, since lesions can have many other causes, but often MS lesions have such distinct patterns that it leaves little doubt. By the time of my first brain/c-spine MRIs (without contrast), I had had MS for at least 30 years, and by then my brain was full of "classic" MS type lesions -- Dawson's Fingers, black holes, etc.

Still, they insisted on confirming the diagnosis with a spinal tap and "evoked potentials" -- all positive. Subsequent thoracic/lumbar MRIs, plus repeat MRIs of my c-spine, show NO spinal lesions. And the contrast has never shown anything different or any active lesions. I have OLD MS.

Good luck to you.

[Shanberger]

Thank you so much for the information. I am having an MRI (with & without)contrast tomorrow of the brain. Would that be enough to determine an initial dx? The MRI of 2009 showed nothing that led them to believe it was MS and I had 2 previous MRI's within the last 10 years that were negative. I'm wondering if it's located in the spine b/c of the leg issues and if so, why wouldn't he want to do the c-spine also? Your thoughts?

[NHE]

I'm wondering if it's located in the spine b/c of the leg issues and if so, why wouldn't he want to do the c-spine also? Your thoughts?

I don't know. It's pretty much a standard practice when exploring a possible MS diagnosis. Do you have any symptoms when you tilt your head forward as far as possible? If you do, this can be indicative of lesions in the cervical spine (known as L'Hermitte's sign). I had a lesion in my c-spine at the site of a bulging disk. However, this did not produce the typical L'Hermitte's sign symptoms so the absence of symptoms does not always correlate with the absence of a lesion.

[HappyPoet]

When people talk about being diagnosed by MRI, is that of the brain only?

Since you've already been given good answers, I'm going to take a different perspective for you to consider.

1. Are you absolutely, positively certain you want to be labeled with a diagnosis of MS? It's a very heavy diagnosis with many possible ramifications, and if you have no interest in starting a DMD at this time, you might want to reconsider pursuing the diagnosis for now and just treat symptoms as/if they arise until a symptom comes along that clinches such a diagnosis.

2. Take a good, long look at the differential diagnosis for MS and check how many/how few problems your neuro investigated before you accept an MS diagnosis and start on a DMD.

3. Make sure you get full spinal X-rays, if you haven't already had them, to rule out structural/mechanical issues such as bulging discs, stenoses, osteoarthritis, and vertebral bone spurs, all of which can cause compression of the cord and/or nerve roots. I suggest you ask your primary doc to order the X-rays because neuros have little to no interest in them, BUT there could still be big problems with your spine that are affecting your cord.

4. Read copies of all reports--past, present, and future. Regarding neuros, do not rely on them to tell you about everything written in imaging reports.

Edit- added italicized words in No. 3

[Shanberger]

Good advice. But I tell you, if I could stop the burning around my ankles, I would be more than happy to forget about a diagnosis.

[HappyPoet]

Burning ankles sound just awful. If you haven't already tried prescription 'Lidocaine HCI 3% Cream,' you might find it helps with your ankle pain. I use Lidocaine patches on my ribcage, and they help much more than I thought they would. I think you should push for the cervical MRI.

[HappyPoet]

Here are the indications for the Lidocaine cream:

"For temporary relief of pain and itching associated with minor burns, sunburn, minor cuts, scrapes, insect bites, and minor skin irritation."

Also, I edited No. 3 of my original post above.