Regarding tumefactive demyelinating lesion, its image diagnosis, and discussion

Liao, Pen Yuan; Chen, Cheng-Yu

doi:10.1016/j.ajem.2014.10.024

Cited by 1 publication

(2 citation statements)

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“…[ 4 7 ] Series consisting of cases of biopsy-confirmed tumefactive MS suggest that lesions without significant mass effect may help differentiate MS lesions from other space-occupying lesions. [ 13 14 18 22 ]…”

Section: Discussionmentioning

confidence: 99%

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Transtentorial herniation from tumefactive multiple sclerosis mimicking primary brain tumor

Vakharia¹,

Kamal²,

Atwal³

et al. 2018

Surg Neurol Int

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Background:Multiple sclerosis (MS) is a chronic central nervous system inflammatory demyelinating disease characterized by multiple lesions disseminated in time and space. The lesions often have characteristic imaging findings on magnetic resonance (MR) imaging and cerebrospinal fluid findings that lead to their diagnosis. At times, these lesions may resemble tumors due to their large size (>2 cm), significant vasogenic edema, and ring-enhancing MR imaging findings. Such lesions are described as tumefactive demyelinating lesions or tumefactive MS, and they are generally seen in aggressive forms of MS associated with rapid progression.Case Description:We report an uncommon but clinically significant case of transtentorial brain herniation secondary to malignant cerebral edema from tumefactive MS in a 50-year-old woman. After the initial diagnosis of MS, the patient continued to have progression of her white matter lesions suggesting evolution of her MS despite treatment with intravenous (IV) steroids, IV immunoglobulin, and plasmapheresis. She was admitted to the hospital with a new, large, ring-enhancing lesion that displayed significant mass effect from vasogenic edema and progressed, necessitating a decompressive hemicraniectomy.Conclusion:Tumefactive MS presents a unique pathology that can often mimic primary brain tumors. Although these lesions affect white matter and infrequently cause a significant amount of mass effect, they can act like a tumor, causing edema that generates sufficient intracranial pressure to cause transtentorial herniation.

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Section: Discussionmentioning

confidence: 99%

“…[ 9 ] Most case reports describe lesions leading to subfalcine herniation. [ 14 18 22 ] Only two cases have been described in which MS presented with transtentorial brain herniation. The first case was described in 2001 of a cystic ring-enhancing frontal lesion that showed moderate mass effect on the lateral ventricles.…”

Section: Introductionmentioning

confidence: 99%