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Fig. 1

MRI studies of demyelinating lesions (plaques). (A) Lesions within corpus callosum by FLAIR sagittal sequence (Dawson’s fingers). (B) A subcortical WM demyelinating lesion (blue arrows) of left temporal lobe. (C) A demyelinating lesion of the posterior column of cervical spinal cord (cross-sectional view). (D) A demyelinating lesion of the cervical spinal cord (sagittal view). FLAIR, fluid-attenunated inversion recovery.

Fig. 2

Compared with the brain MRI of 2017 study, cerebral cortical atrophy with hippocampal atrophy of bilateral temporal lobes (blue arrows) is evidently seen in the 2020 study.

Fig. 3

External examination of the patient’s brain following fixation was remarkable for the presence of cerebral atrophy (arrows) involving the bilateral frontal lobes, anterior parietal lobes, and superior temporal lobes. Coronal sections revealed scattered areas of suspected demyelination (circle) scattered throughout the cerebral WM.

Fig. 4

(A, C) Hematoxylin and eosin/Luxol fast blue. (B) Neurofilament immunohistochemistry. (D, F) Beta-amyloid immunohistochemistry. (E) Phosphorylated tau (AT8) immunohistochemistry. (A) Microscopic examination revealed scattered areas of demyelination, shown as areas of pallor on Luxol fast blue staining (arrowhead), within the cerebral WM. Note the adjacent normal gray matter structures (Caudate nucleus, insular cortex; arrows) above and below the area of demyelination, respectively (2× magnification). (B) Staining for neurofilament highlights preserved axons (arrows) within the area of demyelination (40× magnification). (C) Both granulovacuolar degeneration (arrowhead) and Hirano bodies (arrow) are seen within the hippocampal formation (40× magnification). (D) Staining for beta-amyloid revealed numerous diffuse and mature plaques (arrows) within the prefrontal cortex (20× magnification). (E) Staining for phosphorylated tau highlights numerous neurofibrillary tangles (arrows) and threads within the occipital cortex, including the line of Gennari (20× magnification). (F) Staining for beta-amyloid highlights scattered diffuse plaques (arrow) within the pons (40× magnification).

The recent advance in disease-modifying therapies (DMTs) continues to improve the quality of life in patients with multiple sclerosis (MS) by controlling central nervous system inflammation and preventing neurodegeneration. Although DMTs have reduced the burden of neuropsychiatric symptoms in MS, persistent cognitive impairment of MS can still affect daily living. Therefore, proper intervention and therapies can be provided by the specialists; the concerning caregivers will be informed in time of the complicated comorbidity situation so that they can prepare for the care plan.

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Note: Mohona Reza, Emily Federo Hungria, Michael Kritselis, and Victoria Sanborn contributed equally to this article; they were all mentored by the senior authors Jonathan F. Cahill, Laura Stanton, John E. Donahue, and Chuang-Kuo Wu for this project.


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