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Thread: Ms without evident plaques

  1. #1
    Senior Member skippy13's Avatar
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    Ms without evident plaques

    I am asking for a friend...

    1. Is it possible to have MS without brain plaques showing up on an MRI or even being present?

    2. Can the plaques heal and not be seen on MRI?

    3. I know that plaques usually show up in the white matter of the brain, but is there a possibility that they can be in the other tissue of the brain and show up as a scar?

    4. What if a person has only one spot on the brain, and it is in the wrong place? Can they get a diagnosis of MS?

    5. I know that the spinal cord has never been looked at on MRI, so there is the possibility of them being present on there.

    6. Is a spinal tap indicated for this person who has every physical manifestation and documented symptom of MS including many of the rarer ones like Adie's pupils
    and trigeminal neuralgia.

    7. Would a spinal tap even be worth the risk to find out if this person has MS?

    This person has been struggling to get by without a firm diagnosis for many years. She is losing more and more function and is having more and more "heaviness" in the limbs, and is having extreme balance problems.

    Can anyone help us to find out what kind of doc would give the most bang for the buck so to speak? She has limited resources.

    Any replies will be sincerely appreciated, especially from the medical staff.

    Amy
    Anything worth doing, is worth doing to excess

  2. #2
    Yes, MS can be diagnosed without a positive MRI scan. If your friend has suspected MS for years, he/she is probably aware of this. Difficulty and delay in diagnosis seems to be common. However, other diseases have to be ruled out. If you google "limboland" you will find other forums and threads where the problems with diagnosis are often discussed. This may help put things in perspective, and provide the right information for your friend.

  3. #3
    Senior Member skippy13's Avatar
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    Other diseases have been ruled out.

    She is having eye problems now that come on in the beginning of the "low light" winter months. The eyes do not track the same, the pupillary responses are decidedly unequal (as seen and documented by 2 opthalmologists) and there is a shimmer when trying to focus on medium distance objects. She gets constant headaches because of the eye problems.

    For some reason all of the problems get worse just at the end of summer, like exhaustion takes over and the body can no longer resist giving up and all systems go haywire.

    She just cannot get a firm diagnosis of MS that will allow her to get the help that she needs.

    Is there anyone else that has some helpful suggestions or answers to the questions that I previously asked?
    Anything worth doing, is worth doing to excess

  4. #4
    I understand how your friend feels. When I was told I had 'possible' MS I thought 'what use is this as a diagnosis?'. However, I have some sense of being able to help myself using natural therapies, and other choices. If you read limboland threads you will see (1) most people go to several neuro's before they find one who they feel listens and believes them (many MS symptoms are subjective) (2) there are a great many discussions of MRI's, spots on brain, spinal cord, spinal taps etc - great source of information (3) there's lots of people out there going through exactly the same thing - the support is good (4) other people with exactly the same weird symptoms discuss them, a few 'experts' chime in - and you find what the cause is, or what will bring relief. I recommend the following forum, as it is so active and has so many new threads each day I don't keep up - I just occasionally read the ones that concern me.
    Remember the treatments that neurologists offer (DMM's) reduce the chance of relapse, but are not a cure, and eventually each person has to find out how best to try to stay 'well'. http://www.msworld.org/forum/ good luck.

  5. #5
    Here's an example of a diagnosis discussion...I had to cutnpaste to make this link work...
    ttp://www.msworld.org/FORUM/showthread.php?t=98852

  6. #6
    Senior Member skippy13's Avatar
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    Thank you Greer, I will pass on this link and info to the girlfriend.
    Anything worth doing, is worth doing to excess

  7. #7
    Senior Member skippy13's Avatar
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    I was unable to find what I was looking for on the website. There is too much comparison of symptoms and not enough science to back it up. They seem to be looking at the personal minutiae more than the overall disease. Sorry, just my opinion.

    This person for whom I am speaking has been suffering from optic neuritis and all sorts of other typical symptoms of
    MS for many years. Progressive muscle weakness and wasting, bladder and bowel problems. All for her are relatively short lived and by the time the doc sees her are almost entirely resolved, so no diagnosis even though the muscle wasting and weakness are still present.

    Will a lumbar puncture give her the diagnosis she needs?

    Is a 3T the best MRI for this person?

    Can there be MS diagnosed without the plaques being present on the brain and brainstem, and only a LP that may show positive?
    Last edited by skippy13; 12-11-2009 at 04:16 PM.
    Anything worth doing, is worth doing to excess

  8. #8
    Skippy, PM me privately. I have a dear friend with MS who (I hope) may be able to answer your question. She may have some insight and/or websites with info. I'll forward your PM to her with an intro and see if she can help. Sorry that that's the best I can do for ya. I was screened for MS about 7 years ago, and while I have symptoms, i don't have plaque either (or at least I didn't, at that time). I admit, it's time for a re-check.

  9. #9
    Senior Member skippy13's Avatar
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    I PM'd you, Thanks.
    Anything worth doing, is worth doing to excess

  10. #10
    skippy, let me try to answer your individual questions, based on what I know from having attended many MS meetings and reading many sources (as opposed to internet searched information). My answers are in red.

    Quote Originally Posted by skippy13 View Post
    I am asking for a friend...

    1. Is it possible to have MS without brain plaques showing up on an MRI or even being present? Yes, you can have MS without plaques. A plaque only develops when there is a large collection of inflammatory cells around an area of demyelination. Often the demyelination is small and the inflammation is not severe. When you get plaques, that is strong evidence for MS but absence of plaques does not rule out MS.

    2. Can the plaques heal and not be seen on MRI? Yes, plaques do heal and resorb. In fact, such changes in plaques is an outcome measure in MS research.

    3. I know that plaques usually show up in the white matter of the brain, but is there a possibility that they can be in the other tissue of the brain and show up as a scar? What matter is present in many parts of the brain. Subcortical white matter, for example, lies underneath the superficial layer of the cortex. But, there are myelinated fibers in many parts of brain. Demyelination can occur wherever there is myelin.

    4. What if a person has only one spot on the brain, and it is in the wrong place? Can they get a diagnosis of MS? By "wrong place", I assume that you are talking about gray matter. Areas of demyelination in brain and spinal cord do not always look like "plaques". People who have MS can also have lesions that are not related to their MS. So, the presence or absence of MRI abnormalities in the brain or spinal cord that do not look like plaques neither rule in or rule out MS. On the other hand, if the brain and spinal cord show multiple plaques that are typical of MS, the diagnosis of MS is usually concluded.

    5. I know that the spinal cord has never been looked at on MRI, so there is the possibility of them being present on there. To my knowledge, plaques are often present in the spinal cord in people with MS. I am not sure I understand your statement. For example, here is a 1995 paper that describe spinal cord plaques (Source)

    6. Is a spinal tap indicated for this person who has every physical manifestation and documented symptom of MS including many of the rarer ones like Adie's pupils and trigeminal neuralgia. If the diagnosis is in question, lumbar puncture collected cerebrospinal fluid may show immunoglobulins in the fluid, which would support an autoimmune disease like MS.

    7. Would a spinal tap even be worth the risk to find out if this person has MS? Yes, this is because there are effective treatments for preventing MS progression. Because the therapies are expensive, there is the need for a diagnosis. A lumbar puncture would be justified.

    This person has been struggling to get by without a firm diagnosis for many years. She is losing more and more function and is having more and more "heaviness" in the limbs, and is having extreme balance problems.

    Can anyone help us to find out what kind of doc would give the most bang for the buck so to speak? She has limited resources. She needs an experienced neurologist.

    Any replies will be sincerely appreciated, especially from the medical staff.

    Amy
    Last edited by Wise Young; 12-13-2009 at 11:42 AM.

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