A multiple sclerosis diagnosis can be a sticky widget, so to
speak. This identification is rarely simple, and it tends to take multiple
forms of evidence to determine.
Generally, neurologists will rely on magnetic resonance
imaging (MRI), along with the possible additions of Sensory
Evoked Potentials (SEP) testing, visual exams, anecdotal and symptomatic
information, an in-office neurological examination, and perhaps a spinal tap (also
known as a lumbar puncture).
What is a spinal
tap / lumbar puncture?
This test involves the collection of cerebrospinal fluid from the patient’s spine, using a large hollow needle, which is inserted directly into the lower back. A lumbar puncture may be performed to diagnose any number of neurologically related conditions, including multiple sclerosis.
This test involves the collection of cerebrospinal fluid from the patient’s spine, using a large hollow needle, which is inserted directly into the lower back. A lumbar puncture may be performed to diagnose any number of neurologically related conditions, including multiple sclerosis.
The test carries multiple
risks, such as:
- Back pain
- Bleeding (external or epidural)
- Brainstem herniation
- Dizziness
- Headache
- Infection
- Nausea and vomiting
- and more.
Plus, a lumbar puncture can be downright uncomfortable, to
say the least.
I basically cross-examined my neurologist about the lumbar
puncture, when she brought up the idea. At the time, I’d already undergone
multiple MRIs, the SEP, a host of neuro-ophthalmology tests, and several extensive
medical histories.
Our discussion went
something like this.
“So the lumbar puncture is both
uncomfortable and potentially risky, right?”
“Yes,
that is so.”
“And I could experience a horrific headache
and possibly some dangerous side effects?”
“Yes.
But we could follow up with a blood patch, if you have the post-procedural
migraine.”
“Will the spinal tap change the treatment
plan you propose?”
“Not
really.”
“Will it lead to a more definite diagnosis?”
“Maybe
not.”
“Would the lumbar puncture offer conclusive
evidence of MS?”
“Probably
not.”
“Please tell me again why I need to go
through the procedure.”
Maybe I just
developed a strong backbone.
I opted out. And I still received the same diagnosis.
That may not be true for everyone dealing with possible MS.
Certainly, not all MS diagnoses can occur without this
test. And I would find no fault with
anyone else’s medical testing decisions. The choice is between patient and
doctor.
But I learned an
important lesson in this process.
The patient is his or her own best
advocate, when it comes to medical care. And, in my own case, I chose to
take a pass on the spinal tap.
Hey, I already have enough killer headaches without upping
the ante with an invasive central nervous system procedure.
Image/s:
Vintage painting by Walter Crane
late 19th C
public domain
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Finally...found one of your blogs where comments are possible. Took 4 clicks. First the google+page, then I made my way though several of your blogs, before getting here. I'll change the link to your blog to this one, since you're not using the other one and you have several with comments closed. Sorry I didn't realize you were doing the a-z elsewhere. I always ask the doctors if I were your wife, or when I was younger your daughter, would you tell me to have this procedure. Funny, how that often changed their answers. Good for you!
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