Multiple Sclerosis Journal - October 2017 - 1561

MP Amato
Furthermore, despite the absence of contrast-enhancing lesions on a single MRI study, we believe that the
rapid evolution of symptoms and the extensive brain
damage is subsequent to an active chronic inflammation that, as previously demonstrated, is not necessarily detected with standard studies. Taken together, our
findings suggest that this patient has a peculiar aggressive form of progressive MS, which should be considered as a progressive active MS, deserving the start of
an immunosuppressive treatment.9
Conclusion
In conclusion, MS presenting primarily with cognitive impairment and behavioral abnormalities and
relative sparing of other neurological domains is as
a rare and sometimes unrecognized phenotype.
Interestingly, despite this case meeting the 2010
McDonald Criteria for PPMS, both brain MRI and
neuropsychological assessment are unusual. Early
diagnosis is fundamental for a correct management
and we believe that, considering the young age, the
high lesion load, and the presence of "not evident"
active inflammation, an active immunosuppressive
therapy should be started.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this article.

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The diagnostic dilemma of multiple sclerosis presenting with
isolated cognitive and behavioral disorders
Maria Pia Amato

Abstract: Cognitive and behavioral symptoms are common in multiple sclerosis (MS), even from the
early stages of the disease, but they are considered to be rarely the inaugural and predominant manifestation of the disease, thus jeopardizing early and accurate diagnosis. This clinical commentary highlights
a number of peculiar characteristics that should be taken into consideration in case of primary cognitive/
neuropsychiatric dysfunction and white matter lesions of unclear origin, in order to prompt appropriate
diagnostic workup.
Keywords: Multiple sclerosis, cognitive, psychiatric, presentation

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Multiple Sclerosis Journal
2017, Vol. 23(11) 1561-1563
DOI: 10.1177/
https://doi.org/10.1177/1352458517702550
1352458517705002
https://doi.org/10.1177/1352458517702550
© The Author(s), 2017.
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Correspondence to:
MP Amato
Section Neurosciences,
Department NEUROFARBA,
University of Florence, Largo
Brambilla 3, Florence 50134,
Italy.
mariapia.amato@unifi.it
Maria Pia Amato
Section Neurosciences,
Department NEUROFARBA,
University of Florence,
Florence, Italy

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