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Real members of MyMSTeam have posted questions and answers that support our community guidelines, and should not be taken as medical advice. Looking for the latest medically reviewed content by doctors and experts? Visit our resource section.

If a CSF did not have the markers for MS, but you have brain and spinal lesions and dozens of symptoms, how are you diagnosed?

A MyMSTeam Member asked a question 💭
Dorothy, NJ

I have received no treatments specific to MS, but my condition has worsened significantly, and what I believe to be flares or relapses are happening more frequently and for longer periods of time. I also have RA, was hospitalized with Felty Disease related to RA, Fibromyalgia, Diabetes, Spinal Stenosis, Degenerative Disc Disease, Scoliosis, had Epstein Barr, had anterior discectomy and fusion of my C-spine on 2 levels. I have a plethora of symptoms.

August 7
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MyMSTeam

What a genuinely complex and exhausting situation to be navigating — and it makes complete sense to want clearer answers, especially when symptoms keep worsening.

The good news is that a CSF spinal tap showing no MS markers does not automatically rule out MS. Not everyone with MS shows abnormalities in their cerebrospinal Show Full Answer

What a genuinely complex and exhausting situation to be navigating — and it makes complete sense to want clearer answers, especially when symptoms keep worsening.

The good news is that a CSF spinal tap showing no MS markers does not automatically rule out MS. Not everyone with MS shows abnormalities in their cerebrospinal fluid. Diagnosis is based on a combination of evidence, not any single test. Doctors use the McDonald Criteria to diagnose MS, which looks at multiple factors together:

- Lesion location — damage in two or more separate areas of the central nervous system
- Lesion timing — evidence that damage occurred at different points in time
- MRI findings — brain, spinal cord, and optic nerve scans
- CSF biomarkers — helpful but not always required
- Ruling out other causes — eliminating conditions that mimic MS symptoms Given the complexity of your situation — with multiple overlapping conditions, worsening symptoms, and more frequent relapses — it would be strongly worth pushing for a referral to an MS specialist (an MS neurologist), if you haven't already seen one.

A general neurologist may not have the specialized experience to untangle what's MS-related versus what's connected to your other conditions. An MS specialist is better equipped to look at the full picture. It's also worth knowing that the McDonald Criteria were updated in 2024, expanding what counts as diagnostic evidence. This means someone who may not have met the criteria previously could potentially meet them now.

Advocating firmly for yourself — and asking specifically about the updated criteria — is completely reasonable given how long this has been going on without targeted treatment.

August 7

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