Multiple sclerosis and brain tumor: A diagnostic challenge

Paley, Richard J.; Persing, John A.; Doctor, Allan; Westwater, Jay J.; Roberson, John P; Edlich, Richard F.

doi:10.1016/0736-4679(89)90353-3

Cited by 30 publications

(13 citation statements)

References 23 publications

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“…These lesions more commonly occur in women with an average age of 37 years [1,2]. Symptoms are generally atypical for multiple sclerosis and usually relate to the presence of a focal mass lesion: focal neurologic deficit, seizure, or aphasia [3]. Although the exact pathogenesis is not clearly understood, most patients respond favorably to corticosteroid therapy and do not progress to multiple sclerosis [1].…”

mentioning

confidence: 99%

“…Pathologically, these lesions are indistinguishable from typical multiple sclerosis plaques and are characterized by infiltrating foamy macrophages intermingled between reactive astrocytes [3]. Tumefactive demyelinating lesions have been misinterpreted as gliomas, with the correct diagnosis being revealed only after histologic evaluation [2,3]. The axons are relatively preserved within the lesions, but more recent investigation has shown axonal jury within multiple sclerosis plaques.…”

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confidence: 99%

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The MRI Appearance of Tumefactive Demyelinating Lesions

Given

Stevens

Lee

2004

American Journal of Roentgenology

127

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Pictorial Essay D Fig. 1.-21-year-old woman presenting with new-onset seizure and biopsy-proven tumefactive demyelinating lesion. A, Enhanced axial T1-weighted spin-echo image reveals large left frontal lesion with incomplete ring of enhancement (arrow), open on gray matter side of lesion. There is faint enhancement within dilated, centrally located venous structures (arrowhead), suggestive of demyelinating lesion. B, Enhanced coronal T1-weighted spin-echo image reveals large left frontal lesion with incomplete ring of enhancement (arrow). C, Unenhanced axial T2-weighted spin-echo image reveals relatively little mass effect or surrounding vasogenic edema given size of lesion.

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confidence: 99%

mentioning

confidence: 99%

The MRI Appearance of Tumefactive Demyelinating Lesions

Given

Stevens

Lee

2004

American Journal of Roentgenology

127

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“…In many cases, reliable differentiation of neoplastic from nonneoplastic brain masses is difficult, or even impossible, with conventional MR imaging. [1][2][3][4][5][6] In these cases, information provided by additional MR techniques may be of help. Proton MR spectroscopy ( 1 H-MR spectroscopy) is a noninvasive MR technique that provides biochemical information from tissues that has proved useful in discriminating between tumor types [7][8][9][10][11][12] as well as discriminating between tumors and pseudotumors.…”

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confidence: 99%

Proton MR Spectroscopy Improves Discrimination between Tumor and Pseudotumoral Lesion in Solid Brain Masses

Majós¹,

Aguilera²,

Alonso³

et al. 2008

AJNR Am J Neuroradiol

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“…Pathologic confirmation in MS suspects is not usually practical given the invasiveness of brain biopsy. 8 The lack of specificity of MRI 9 limits its usefulness as a gold standard. We concluded that the eventual development of CDMS was the best available independent gold standard to evaluate the usefulness of EP-identified silent lesions in MS suspects.…”

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confidence: 99%

Practice parameter: The usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review)

Gronseth

Ashman²

2000

Neurology

123

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The Quality Standards Subcommittee of the American Academy of Neurology (AAN) is charged with developing practice parameters for neurologists for diagnostic procedures, treatment modalities, and clinical disorders. The selection of topics for which practice parameters are used is based on prevalence, frequency of use, economic impact, membership involvement, controversy, urgency, external constraints, and resources required. This article addresses the usefulness of evoked potentials (EPs) in identifying clinically silent lesions in patients with suspected MS.The diagnosis of MS remains primarily clinical, requiring evidence of white matter lesions disseminated in space and time.1,2 Some patients with suspected MS not fulfilling clinical dissemination criteria (MS suspects) have abnormal EPs that identify clinically unsuspected lesions.3,4 Current diagnostic criteria allow MS suspects to be reclassified into definite MS categories if EPs identify clinically silent lesions.2,5 The identification of clinically unsuspected lesions is one major reason clinicians use EPs in MS suspects. 4,6 Presumably, MS suspects with EP-identified clinically silent lesions are more likely to have MS and are at higher risk for developing MS-related disabilities. Accurately identifying these high-risk patients will become increasingly important if early therapies are demonstrated to be effective in preventing or delaying disability in patients with MS.To determine the effectiveness of EP-identified silent lesions in diagnosing MS, we performed a systematic review and analysis of the literature. Based on this review we propose practice parameters for the use of EPs in patients with suspected MS.Process. Confirmation of the ability of EP-identified clinically silent lesions to diagnose MS requires a comparison with an independently verifiable gold standard.7 Potential gold standards include pathologic confirmation of MS lesions, brain MRI, or the eventual development of clinically definite MS (CDMS). Pathologic confirmation in MS suspects is not usually practical given the invasiveness of brain biopsy. 8 The lack of specificity of MRI 9 limits its usefulness as a gold standard. We concluded that the eventual development of CDMS was the best available independent gold standard to evaluate the usefulness of EP-identified silent lesions in MS suspects.To find articles describing the relationship between EP findings and the development of CDMS, we searched the National Library of Medicine's Medline database for articles published from 1966 to January 1998, using the terms multiple sclerosis and evoked potentials. We subsequently screened the search result articles and their bibliographies for articles discussing EPs in the diagnosis of MS. We selected those studies that followed MS suspects evaluated with EPs for the development of CDMS. We eliminated articles that did not employ standard EP techniques. 10From the articles fulfilling these criteria we abstracted the following methodologic characteristics: the method and setting of cohort as...

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Multiple sclerosis and brain tumor: A diagnostic challenge

Cited by 30 publications

References 23 publications

The MRI Appearance of Tumefactive Demyelinating Lesions

The MRI Appearance of Tumefactive Demyelinating Lesions

Proton MR Spectroscopy Improves Discrimination between Tumor and Pseudotumoral Lesion in Solid Brain Masses

Practice parameter: The usefulness of evoked potentials in identifying clinically silent lesions in patients with suspected multiple sclerosis (an evidence-based review)

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