A Case of Cortical Multiple Sclerosis.

Dear Editor, Multiple Sclerosis (MS) is a chronic progressive demyelina-ting disease of the central nervous system. Cognitive dysfunc-tion (CD) is usually observed at advanced stages of the disease but CD may be rarely observed at the initial stages of MS. Very unusually, MS presents primarily as CD; when this presentation occurs, it is referred as " cortical " or " cerebral " MS in the relevant literature (1). A case of a patient diagnosed with cortical MS, beginning with complaints of forgetfulness, and clinical benefit from treatment with donepezil was reported in this article. The male patient with right hand dominance was aged 47 years and graduated from primary school. He was admitted with complaints of forgetfulness and difficulty in walking. We learned from his story that he had gradually increasing complaints of forgetfulness for 5 years; he could not remember words that he wanted to say since the last year, and he was unable to perform daily tasks and had impaired self-care. Also, he had weakness in the legs during the last 14 months. Psychomotor retardation, disorientation, hypophonia, faltering speech, bilateral temporal pallor at fundus, left central facial paralysis, reduction in vibration sensation in all four extremities, loss of position sense in the lower extremities, +4/5 monoparesis at right lower extremity , and ataxia at tandem gait were observed on conducting neurological examination. Minimental state examination was scored as 17/30, digit span forward score of 4, digit span backward score of 3, verbal fluency of 7/min (perseveration, 2/min), phonemic fluency of (character K) 5/min (perseveration, 0/min), abstraction of 1/3, clock drawing score of 7/10, verbal learning test score at the 5th min of 1/3, recall memory score of 1/3 on performing neurocog-nitive assessment. It was reported as temporolimbic memory, attention, and executive function defects. Progressive dysfunction of cognitive abilities, affected pyra-midal system, and affected deep sensory system were observed in this patient. Therefore, neurodegenerative processes avita-minosis, chronic infections, chronic metabolic and systemic diseases , mitochondrial diseases, and paraneoplastic processes were investigated. Abnormality was not detected in these tests. Cerebrospinal fluid (CSF) biochemistry, cytology, and IgG index was observed in the normal range. Oligoclonal bands were not detected in CSF. With bilateral PR stimulation, late latency was observed at visual evoked potentials and deformed response on the left side. EEG examinations that were performed in a 2-month period were within the normal range. Cerebral and cervical MR angiography examinations were …