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Is Multiple Sclerosis Diagnosed Only By T2 Lesions In Brain?
Question: Good Morning - I had a blood vessel burst in my right eye. Went to the ER and an MRI was done. It showed "Numerous high T2 signal lesions predominately in the cerebral white matter. Small focus of high T2 signal in the right cerebellar white matter" The Neurologist in the ER said at my age, 65, MS was rare and I have absolutely no other symptoms. They recommended I follow up with the Neurologist. I did and he did all of his tests, which I passed. He never spoke to me until the end and said "You have an abnormal brain and you need a spinal tap." To say I was upset is an understatement. I have an appointment with a Retina specialist this Thursday. My question is this - Can one have MS and have absolutely no other symptoms and MS is diagnosed solely T2 lesions?
Brief Answer:
MS might be there without any clinical symptom
Detailed Answer:
Hi XXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. The MRI diagnosis for Multiple Sclerosis is based on the McDonald criteria which was first applied in the year 2001 and was revised twice, recently modified in the 2010.
2. The criteria specify the presence of suspected disease findings in MRI scan brain and spinal cord which is disseminated in time and space.
4. Dissemination is space requires more than one T2 bright lesions in two or more of the following locations
(i) periventricular
(ii) juxtacortical
(iii) infratentorial
(iv) spinal cord
if a patient has a brainstem / spinal cord syndrome, the symptomatic lesion(s) are excluded from the criteria, not contributing to the lesion count
5. Dissemination in time can be established in one of two ways
(i) a new lesion when compared to a previous scan (irrespective of timing)
T2 bright lesion and/or gadolinium enhancing
(ii) presence of asymptomatic enhancing lesion and a non-enhancing T2 bright lesion on any one scan
6. The confirmed diagnosis of MS is made based on the following
(i) more than 1 year of disease progression (this can be determined either prospectively or retrospectively)
(ii) plus two of the following three criteria
a. brain dissemination in space (more than one T2 bright lesions in more than one of juxtacortical, periventricular, infratentorial areas)
b. spinal cord dissemination in space (more than 2 T2 bright lesions)
c. positive CSF (oligoclonal bands and/or elevated IgG index)
7. There is a clinical condition called asymptomatic MS or subclinical MS which is known as radiologically isolated syndrome (RIS). Therefore it is true that there are people who have signs of MS only on scans without any symptom.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
MS might be there without any clinical symptom
Detailed Answer:
Hi XXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. The MRI diagnosis for Multiple Sclerosis is based on the McDonald criteria which was first applied in the year 2001 and was revised twice, recently modified in the 2010.
2. The criteria specify the presence of suspected disease findings in MRI scan brain and spinal cord which is disseminated in time and space.
4. Dissemination is space requires more than one T2 bright lesions in two or more of the following locations
(i) periventricular
(ii) juxtacortical
(iii) infratentorial
(iv) spinal cord
if a patient has a brainstem / spinal cord syndrome, the symptomatic lesion(s) are excluded from the criteria, not contributing to the lesion count
5. Dissemination in time can be established in one of two ways
(i) a new lesion when compared to a previous scan (irrespective of timing)
T2 bright lesion and/or gadolinium enhancing
(ii) presence of asymptomatic enhancing lesion and a non-enhancing T2 bright lesion on any one scan
6. The confirmed diagnosis of MS is made based on the following
(i) more than 1 year of disease progression (this can be determined either prospectively or retrospectively)
(ii) plus two of the following three criteria
a. brain dissemination in space (more than one T2 bright lesions in more than one of juxtacortical, periventricular, infratentorial areas)
b. spinal cord dissemination in space (more than 2 T2 bright lesions)
c. positive CSF (oligoclonal bands and/or elevated IgG index)
7. There is a clinical condition called asymptomatic MS or subclinical MS which is known as radiologically isolated syndrome (RIS). Therefore it is true that there are people who have signs of MS only on scans without any symptom.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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