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Such changes in the lack of inflammation have been reported in chronic cortical plaques, raising the relevant query of whether swelling and neurodegeneration are independent functions in multiple sclerosis.4,7,24 Several cortical lesions that we examined demonstrated neuritic swelling, suggesting acute injury, although almost all demonstrated relative preservation of neurites. We observed serious focal neuritic loss in two subpial lesions . In one patient, a large focal meningeal infiltrate was topographically connected with a destructive subpial lesion . Oligodendrocyte density was reduced in a subset of lesions, as compared with adjacent, nondemyelinated cortex . Focal neuronal damage was apparent in several early cortical plaques . Neurodegenerative changes occurred on a background of inflammation .