Cognitive and behavioral symptoms are common in multiple sclerosis (MS), even from the early stages of the disease, but they are considered to be rarely the inaugural and predominant manifestation of the disease, thus jeopardizing early and accurate diagnosis. This clinical commentary highlights a number of peculiar characteristics that should be taken into consideration in case of primary cognitive/neuropsychiatric dysfunction and white matter lesions of unclear origin, in order to prompt appropriate diagnostic workup.
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