How Did They Diagnose Ms Before Mri's?

Question

Asked by KJ

How Did They Diagnose Ms Before Mri's?

I am in limbo. Today my GP told me that I'm right to be concerned that I have MS. He says I have several symptoms as well as white matter lesions, and my neurologist is trying to eliminate MS as a cause. Unfortunately most of my symptoms are vision related (double vision, lack of clear vision in the center of my field of view, colors look different between the two eyes, flashes of light, large black spot on one side, etc.) Since I was just diagnosed with a tumor in my eye (probably benign "orbital tumor" not that close to the optic nerve), the docs don't want to consider any vision symptoms until this thing is either removed or biopsied in place and found to not be a problem. Other symptoms I have are cognitive issues (Dude, where's my car?), intention tremor (sometimes bad), ticks and twitches, odd sensations (feels like drops of ice water on my back, stomach, and sides), GERD, and bladder and other issues "down there".

Getting back to my original question. I've read that MS used to be diagnosed by putting a patient in a hot bath and checking the symptoms/effects. When I have a hot bath I have a temporary but significant worsening of any of the above symptoms. I also have fatigue so bad I can barely get out of the tub at times. Would this have been enough for a diagnosis 30 or 40 years ago?

I see the eye surgeon July 13th and will try to schedule a spinal tap before then. I guess I'll be in limbo for awhile longer. Thanks for listening.

Answer

Hi KJ,

Sorry to hear your frustration. Before MRIs, there was a long process. Generally, the Schumacher criteria were used before the McDonald criteria that are used today.

A typical diagnosis process includes these things --

Case history over time
Family history
Symptom description
Neuro exam - reflexes, sense, muscle strength, eyesight, balance, -- looking for ataxia, clumsiness, spinal cord or neck lesions
Optic neuritis
Motor neurons
Lesions in hand and foot, tested by checking involuntary movement following pressure at pressure point
Evoked potential tests
Spinal tap
At least two definite attacks

Even today, the MRI is not enough. Sometimes lesions do not show up in a brain MRI, so a spine MRI is needed. Even so, multiple attacks are needed. The temperature test is an important sign, but it does not mean definite MS without other signs.

So sorry to say this, but it will take time. Good luck and patience.

Answered by Vicki