title: A case of multiple sclerosis presenting with inflammatory cortical demyelination.
abstract: OBJECTIVE
  To describe a patient presenting with a clinically silent, incidentally found, and pathologically confirmed active demyelinating solitary cortical lesion showing MRI gadolinium contrast enhancement, in whom biopsy was performed before the radiographic appearance of disseminated white matter lesions.
  
  
  METHODS
  Neurologic examination, MRI, CSF and serologic analyses, and brain biopsy were performed. Sections of formalin-fixed paraffin-embedded biopsied brain tissue were stained with histologic and immunohistochemical stains.
  
  
  RESULTS
  Biopsy revealed an inflammatory subpial lesion containing lymphocytes and myelin-laden macrophages. Recurrent relapses with dissemination of MRI-typical white matter lesions characterized the subsequent course.
  
  
  CONCLUSIONS
  Our findings highlight that cortical demyelination occurs on a background of inflammation and suggest that the noninflammatory character of chronic cortical demyelination may relate to long intervals between lesion formation and autopsy. This case provides pathologic evidence of relapsing-remitting MS presenting with inflammatory cortical demyelination and emphasizes the importance of considering demyelinating disease in the differential diagnosis of patients presenting with a solitary cortical enhancing lesion.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: B F Gh
authors.initials: BF
authors.lastname: Popescu
authors.forename: R F
authors.initials: RF
authors.lastname: Bunyan
authors.forename: J E
authors.initials: JE
authors.lastname: Parisi
authors.forename: R M
authors.initials: RM
authors.lastname: Ransohoff
authors.forename: C F
authors.initials: CF
authors.lastname: Lucchinetti
mesh_terms: D000328:Adult; D001706:Biopsy; D002540:Cerebral Cortex / Q000473:pathology*; D003711:Demyelinating Diseases / Q000150:complications / Q000473:pathology*; D005260:Female; D000068717:Glatiramer Acetate; D006261:Headache / Q000209:etiology; D006423:Hemianopsia / Q000150:complications; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008881:Migraine Disorders / Q000150:complications; D020528:Multiple Sclerosis, Chronic Progressive / Q000150:complications / Q000473:pathology*; D016612:Paraffin Embedding; D010455:Peptides / Q000627:therapeutic use; D016707:Tissue Fixation
chemical_list: D007166:Immunosuppressive Agents; D010455:Peptides; D000068717:Glatiramer Acetate