Can MS be diagnosed without lesions?

[Toby1984]

My GP believes I have MS. I was sent to a neurologist who didn't do a full neuro exam and said nope, MS isn't possible. Well, my GP didn't accept this because the neurologist I seen has a very bad reputation and, come to find out, is known for sending away patients who show signs of MS. I went just this last Monday to a well-known MS clinic. After a complete and thorough neuro exam, the first thing said to me was "Has anyone told you that you have MS before? Because your symptoms and neuro exam definitely point to MS."

My MRI in April showed no lesions, but the the neurologist at the MS clinic said that doesn't mean anything at all and that my images were very poor quality. He ordered a ton of blood tests to rule out MS mimics. I received those results today and everything was negative, and my MMA result showed my B12 levels are fine. I also have classic low vitamin D levels (mine was 11 in March). I have a positive Babinski sign, Uhthoff's, intention tremor, and my other symptoms do point to MS. I have an appointment next week for an LP, and I will be having an EMG and a visual evoked potentials test in June. My last two eye exams have resulted in "abnormal findings" in my right eye, and I had vision loss in my right eye a few years ago that the neurologist believes was ON.

Basically, my question is, can I receive a diagnosis of MS without lesions? I am sick enough that my neurologist wants me to begin the process for disability, but I am concerned that, without lesions, I will not be able to get an official diagnosis, which will make the process harder for me.

Thank you.

[supermum_ms]

Hi again Toby,

I'm glad to hear you did go and get a second opinion with an MS specialising neurologist, your first sounded a tiddly bit useless.  So can you be diagnosed without lesions....MS means many scars so technically you can't have MS with out lesions but i think the question is more to do with MRI evidence of lesions....

There are reasons why an MRI can miss lesions though, your MS neuro mentioned very poor quality but also things like open vs closed, MRI strength 1T, 1.5T, 3T, standard vs MS protocol etc can all make a difference. I would expect your MS neuro will be organising another set of brain and or spinal MRI's along with all the other tests, even if he/she was happy with them, most people are not dx on 1 MRI anyway, so there's usually another set run.

Theoretically MS can be diagnosed without MRI evidence, if you've got neurologically abnormal clinical signs of lesion damage and other test evidence suggestive-consistent, but whilst MS can still be diagnosed without MRI diagnostics, there aren't many neurologist who would diagnose with out a patients MRI meeting the Mcdonald criteria because of the potential of misdiagnosis.  

Hope that helps......JJ