[Cognitive dysfunction as a hidden multiple sclerosis related symptom relevant for an expert appraisal]

We report on a patient with multiple sclerosis (MS), who had severe cognitive dysfunction despite only mild changes in cerebral magnetic resonance imaging (cMRI). The severe MS-related cognitive deficits were disclosed only in a comprehensive neuropsychological evaluation. A previous appraiser was not able to detect these neuropsychological deficits as he did not conduct an appropriate neuropsychological assessment. The expert appraisal had been performed to decide whether the MS-related deficits would make the patient eligible to receive pension payments from a private pension insurance. Only after a subsequent neuropsychological expert appraisal the insurance company had to pay several ten thousands of Euro as decided by judicial decree. The presented case impressingly demonstrates that the so called hidden symptoms of MS such as fatigue or cognitive dysfunction are often not identified by treating physicians and in medico-legal evaluations. We therefore postulate that comprehensive neuropsychological evaluation is mandatory to perform expert appraisals to assess occupational disability in MS patients.