Focal cortical atrophy following transient meningeal enhancement in a progressive multiple sclerosis

Neurol Sci. 2021 May;42(5):1959-1961. doi: 10.1007/s10072-020-04764-0. Epub 2020 Sep 29.


Recent studies identified chronic leptomeningeal enhancement (LME) in late-acquired FLAIR sequences in secondary progressive (SP) multiple sclerosis (MS). These LMEs correlate with focal cortical inflammation and demyelination observed by pathology, which are supposed to drive long-term cortical atrophy. We report a spontaneously remitting meningeal uptake in a patient suffering from SP MS. No cortical lesion was visible on FLAIR or DIR sequences, but the rate of cortical atrophy was higher in this area. This case suggests that conventional 3-T MRI, by contrary to white matter lesions, may be amnesic with regard to the potential burden of previous regressive meningeal lesions. Moreover, T1-enhanced sequences underscore the real inflammatory activity. LME could be more than passive markers of SP MS, but is also directly responsible for focal cortical atrophy and could be an early manifestation of cortical lesions.

Keywords: Cortical atrophy; Leptomeningeal contrast enhancement; Multiple sclerosis; Relapse.

MeSH terms

  • Atrophy / pathology
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / pathology
  • Humans
  • Magnetic Resonance Imaging
  • Meninges / diagnostic imaging
  • Meninges / pathology
  • Multiple Sclerosis* / complications
  • Multiple Sclerosis* / diagnostic imaging
  • Multiple Sclerosis* / pathology
  • Multiple Sclerosis, Chronic Progressive* / pathology