Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Letters   |    
Three Decades of Drift: The Misdiagnosis of Predominantly Neuropsychiatric Multiple Sclerosis
João Passos, M.D.; Ana Azevedo, M.D.; Duarte Salgado, M.D.; Hipólito Nzwalo, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E55-E56. doi:10.1176/appi.neuropsych.13030063
View Author and Article Information

Instituto Português de Oncologia de Lisboa, Francisco Gentil
Lisboa, Portugal

Centro Hospitalar do Algarve
Faro, Algarve

Correspondence: Dr. Nzwalo; e-mail: nzwalo@gmail.com

Copyright © 2014 by the American Psychiatric Association


To the Editor: Neuropsychiatric disturbances, such as behavior, mood, and personality changes, are often recognized during multiple sclerosis (MS) evolution.1 Psychiatric presentation and dominant cognitive MS is very rarely reported, and occurs in less than 1% of cases.2 In this report, we describe a case of MS with predominant cognitive and psychiatric manifestations from the beginning, misdiagnosed as a pure psychiatric disorder for more than three decades.

Figures in this Article

First Page Preview

View Large
First page PDF preview
Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

FIGURE 1. [A]: Sagittal T2-Weighted Brain MRI Showing Multiple Hyperintense Lesions in the Corpus Callosum and the “Dawson's Fingers” (blue arrows); [B]: Axial T1-Weighted MRI Showing Hypointense Lesions, the “Black Holes” (red arrows)

FIGURE 2. Clinical Evolution With Episodes of Transient Neurological Symptoms


Diaz-Olavarrieta  C;  Cummings  JL;  Velazquez  J  et al:  Neuropsychiatric manifestations of multiple sclerosis.  J Neuropsychiatry Clin Neurosci 1999; 11:51–57
Jongen  PJ:  Psychiatric onset of multiple sclerosis.  J Neurol Sci 2006; 245:59Y62
Lyoo  IK;  Seol  HY;  Byun  HS  et al:  Unsuspected multiple sclerosis in patients with psychiatric disorders: a magnetic resonance imaging study.  J Neuropsychiatry Clin Neurosci 1996; 8:54–59
Amato  MP;  Langdon  D;  Montalban  X  et al:  Treatment of cognitive impairment in multiple sclerosis: position paper.  J Neurol 2013; 260:1452–1468
[CrossRef] | [PubMed]
Zarei  M;  Chandran  S;  Compston  A  et al:  Cognitive presentation of multiple sclerosis: evidence for a cortical variant.  J Neurol Neurosurg Psychiatry 2003; 74:872–877
[CrossRef] | [PubMed]
References Container

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 35.  >
DSM-5™ Clinical Cases > Chapter 17.  >
DSM-5™ Handbook of Differential Diagnosis > Chapter 2.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 35.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 35.  >
Topic Collections
Psychiatric News
PubMed Articles