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Tumefactive multiple sclerosis

Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
Tumefactive multiple sclerosis (MS) is characterized by the presence of a single MS-plaque in the brain. It mimics tumors due to large size, mass effect, and enhancement patterns. Refractory intracranial hypertension due to tumefactive MS requiring decompressive craniectomy (DC) was reported in five cases. However, none of these cases were documented new lesions during the follow-up. We report a case of a 28-year-old female admitted with acute right hemiparesis, headache, and nausea. A brain magnetic resonance imaging (MRI) revealed a left parietal lobe lesion...
July 2018: Asian Journal of Neurosurgery
Alaa Nabil Turkistani, Foziah Jabbar Alshamrani, Ghadah Faisal Shareefi, Abdulla Alsulaiman
Introduction: Tumefactive multiple sclerosis is a demyelinating disorder that appears tumor-like on MRI. To most physicians, diagnosing tumefactive MS by applying clinical, radiological, or laboratory examination like Cerebrospinal fluid (CSF) analysis, can be challenging and ultimately biopsy is necessary to confirm the diagnosis. Case presentation: This paper reports a case of a 37-year-old woman who presented with progressive headache and a strong family history of cancer and was misdiagnosed as having a CNS glioma...
August 2018: Electronic Physician
Jenelle Raynowska, Dhanashri P Miskin, Bidyut Pramanik, Saeed Asiry, Todd Anderson, John Boockvar, Souhel Najjar, Asaff Harel
OBJECTIVE: We report a series of 2 brothers who each developed tumefactive brain lesions, initially thought to have brain tumors or tumefactive multiple sclerosis (MS), but who were ultimately diagnosed with a rare autosomal dominant condition known as retinal vasculopathy with cerebral leukoencephalopathy (RVCL). METHODS: Case series and literature review. RESULTS: We present 2 brothers who developed tumefactive right frontal brain lesions leading to gait disturbances and cognitive changes...
September 7, 2018: Neurology
Shoji Yasuda, Hirohito Yano, Akio Kimura, Natsuko Suzui, Noriyuki Nakayama, Jun Shinoda, Toru Iwama
BACKGROUND: Tumefactive demyelinating lesion (TDL) is often reported as a rare variation of multiple sclerosis (MS). TDL is difficult to diagnose solely by magnetic resonance imaging (MRI) in patients with no history of MS. This is because the lesion often shows ring enhancement with perifocal brain edema on gadolinium MRI, thus mimicking glioblastoma multiforme (GBM). CASE DESCRIPTION: A 54-year-old healthy woman complained of headache 1 month before admission...
August 13, 2018: World Neurosurgery
Pedro Sánchez, Virginia Meca-Lallana, José Vivancos
BACKGROUND AND OBJECTIVE: Fingolimod is a sphingosine 1-phosphate receptor modulator, which sequesters lymphocytes in lymph nodes and prevents them from entering the central nervous system. There have been increasing reports of severe rebounds with tumefactive demyelinatinglesions (TDLs) in patients with multiple sclerosis under fingolimod treatment, as well as following therapy discontinuation. Our objective is to review the clinico-radiological characteristics of patients with TDLs associated with fingolimod...
July 19, 2018: Multiple Sclerosis and related Disorders
G Balloy, J Pelletier, L Suchet, C Lebrun, M Cohen, P Vermersch, H Zephir, E Duhin, O Gout, R Deschamps, E Le Page, G Edan, P Labauge, C Carra-Dallieres, L Rumbach, E Berger, P Lejeune, P Devos, J-B N'Kendjuo, M Coustans, E Auffray-Calvier, B Daumas-Duport, L Michel, F Lefrere, D A Laplaud, C Brosset, P Derkinderen, J de Seze, S Wiertlewski
BACKGROUND: Tumefactive demyelinating lesions of the central nervous system can be the initial presentation in various pathological entities [multiple sclerosis (the most common), Balo's concentric sclerosis, Schilder's disease and acute disseminated encephalomyelitis] with overlapping clinical presentation. The aim of our study was to better characterize these patients. METHODS: Eighty-seven patients (62 women and 25 men) from different MS centers in France were studied retrospectively...
July 27, 2018: Journal of Neurology
Ramy Mando, Emile Muallem, Shaiva G Meka, Ramona Berghea
Tumefactive Multiple Sclerosis (TMS) is a rare variant with 1 per 1000 cases of MS and 3 per million cases per year. TMS can mimic clinical and radiological features of a neoplasm, infarction, or abscess and therefore can be diagnostically challenging for clinicians. We present a clinical scenario of a patient presenting with left homonymous hemianopia with atypical radiological features initially thought to be more consistent with neoplasm or infraction. Ultimately, biopsy was done which led to the diagnosis of tumefactive multiple sclerosis...
2018: Case Reports in Neurological Medicine
Afsaneh Shirani, Gregory F Wu, Caterina Giannini, Anne H Cross
Tumefactive appearing lesions on brain imaging can cause a diagnostic dilemma. We report a middle-aged man who presented with right-sided optic neuritis. A brain MRI showed enhancement of the right optic nerve, and non-enhancing white matter lesions including a 3 cm right frontal lesion with adjacent gyral expansion. Cerebrospinal fluid analysis showed five oligoclonal bands not present in serum. Glatiramer acetate was started for suspected tumefactive multiple sclerosis (MS). A follow-up brain MRI 6 months later showed persistence of the frontal gyral expansion...
June 28, 2018: BMJ Case Reports
Dániel Sandi, Edit Bereg, Tamás Biernacki, Erika Vörös, Péter Klivényi, Csaba Bereczki, László Vécsei, Krisztina Bencsik
Multiple sclerosis (MS) is the autoimmune, neurodegenerative disease of the central nervous system (CNS). Typically, it affects the young adult population, however, up to 10% of the cases, it can develop in childhood. Atypical manifestations, such as the tumefactive variant (tMS) or acute disseminated encephalomyelitis (ADEM), especially coupled with fulminant disease course, are even more rare and pose a considerable differential diagnostic and therapeutic challenge. Recently, the therapeutic strategy on the use of disease modifying therapies (DMTs) in MS has shifted to the direction of a more individualized approach, that takes the personal differences heavily into account, in particular regard to the activity and prognosis of the disease...
July 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Kazunori Sato, Masaaki Niino, Atsushi Kawashima, Moemi Yamada, Yusei Miyazaki, Toshiyuki Fukazawa
Objective In Japan, following the launch of dimethyl fumarate (DMF) after fingolimod as a disease-modifying drug in multiple sclerosis (MS), some patients switched from fingolimod to DMF. The aim of this study was to determine the follow-up status of MS patients who switched to DMF after fingolimod cessation. Methods Clinical and magnetic resonance imaging (MRI) data in 19 patients with MS who switched to DMF were collected for at least for 6 months after fingolimod cessation. Results Ten patients (52.6%) experienced clinical or MRI exacerbation after fingolimod cessation...
April 27, 2018: Internal Medicine
Maria Teresa Giordana, Paola Cavalla, Antonio Uccelli, Alice Laroni, Fabio Bandini, Marco Vercellino, Gianluigi Mancardi
We present the neuropathological description of an autoptic case of fatal rebound of disease activity after fingolimod discontinuation in a multiple sclerosis patient. MRI prior to the fatal outcome showed several large tumefactive demyelinating lesions. These lesions were characterized by prominent astrocytic gliosis, with a remarkable preponderance of large hypertrophic reactive astrocytes showing intense expression of sphingosine-1-phosphate receptor 1. Prominent astrocytic gliosis was also diffusely observed in the normal-appearing white matter...
July 2018: Multiple Sclerosis: Clinical and Laboratory Research
Michelle Lin, Patrick Reid, Joshua Bakhsheshian
Tumefactive multiple sclerosis is a demyelinating lesion that can radiographically mimic high-grade gliomas during acute episodes, thus affecting clinical decision making. A delay in appropriate diagnoses can result in unnecessary invasive resections. The following case is a patient with unilateral weakness and radiologic findings that were concerning for a high-grade glioma. Peripheral studies were equivocal. The decision was made to proceed with a stereotactic biopsy, yielding a definitive diagnosis of tumefactive demyelinating lesion (TDL)...
April 2018: World Neurosurgery
Sameen Bin Naeem, Farheen Niazi, Atif Baig, Hina Sadiq, Mubbasher Sattar
Primary CNS (central nervous system) lymphoma is a rare condition with the incidence of less than 1% of all non-Hodgkin lymphomas (NHLs) and approximately 2% of all primary brain tumours. Diagnosis can be challenging and necessitates brain biopsy for definitive diagnosis. A 41-year male presented with history of impaired cognition, facial asymmetry, visual impairment and left sided body weakness. MRI brain demonstrated multiple enhancing lesions with one larger lesion in right basal ganglia with surrounding oedema and mass effect...
January 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Alejandro Enriquez-Marulanda, Jaime Valderrama-Chaparro, Laura Parrado, Juan Diego Vélez, Ana Maria Granados, Jorge Luis Orozco, Jairo Quiñones
Multiple Sclerosis (MS) is an autoimmune disease in which lymphocytes target putative myelin antigens in the CNS, causing inflammation and neurodegeneration. Fingolimod (FTY720) is an immunosuppressive drug used as a second line therapy for relapsing forms of MS due to its safety profile and good response to treatment. Despite its safety, there are still concerns about the possibility of Fingolimod being linked to the development of opportunistic infections like disseminated varicella zoster infections and herpes simplex encephalitis...
November 2017: Multiple Sclerosis and related Disorders
Rana K Zabad, Renee Stewart, Kathleen M Healey
During recent decades, the autoimmune disease neuromyelitis optica spectrum disorder (NMOSD), once broadly classified under the umbrella of multiple sclerosis (MS), has been extended to include autoimmune inflammatory conditions of the central nervous system (CNS), which are now diagnosable with serum serological tests. These antibody-mediated inflammatory diseases of the CNS share a clinical presentation to MS. A number of practical learning points emerge in this review, which is geared toward the pattern recognition of optic neuritis, transverse myelitis, brainstem/cerebellar and hemispheric tumefactive demyelinating lesion (TDL)-associated MS, aquaporin-4-antibody and myelin oligodendrocyte glycoprotein (MOG)-antibody NMOSD, overlap syndrome, and some yet-to-be-defined/classified demyelinating disease, all unspecifically labeled under MS syndrome ...
October 24, 2017: Brain Sciences
Fumihito Yoshii, Yusuke Moriya, Tomohide Ohnuki, Masafuchi Ryo, Wakoh Takahashi
Fingolimod (FTY) is the first oral medication approved for treatment of relapsing-remitting multiple sclerosis (RRMS). Its effectiveness and safety were confirmed in several phase III clinical trials, but proper evaluation of safety in the real patient population requires long-term post-marketing monitoring. Since the approval of FTY for RRMS in Japan in 2011, it has been administered to approximately 5000 MS patients, and there have been side-effect reports from 1750 patients. Major events included infectious diseases, hepatobiliary disorders, nervous system disorders and cardiac disorders...
August 2017: Clinical & Experimental Neuroimmunology
D M Rogers, M E Peckham, L M Shah, R H Wiggins
We present 5 cases of demyelination in patients diagnosed with multiple sclerosis that are closely associated with a developmental venous anomaly. Although the presence of a central vein is a known phenomenon with multiple sclerosis plaques, demyelination occurring around developmental venous anomalies is an underreported phenomenon. Tumefactive demyelination can cause a diagnostic dilemma because of its overlapping imaging findings with central nervous system neoplasm. The relationship of a tumefactive plaque with a central vein can be diagnostically useful, and we suggest that if such a lesion is closely associated with a developmental venous anomaly, an inflammatory or demyelinating etiology should be a leading consideration...
January 2018: AJNR. American Journal of Neuroradiology
Fatemeh Abrishamchi, Fariborz Khorvash
Nonneoplastic demyelinating processes of the brain with mass effect on magnetic resonance imaging can cause diagnostic difficulties. It requires differential diagnosis between the tumefactive demyelinating lesion and the coexistence of neoplasm. We document the case of 41-year-old woman with clinical and radiological findings suggestive of multiple sclerosis. Additional investigations confirmed the coexistence of astrocytoma. This report emphasizes the importance of considering brain tumors in the differential diagnosis of primary demyelinating disease presenting with a cerebral mass lesion...
2017: Advanced Biomedical Research
Konstantin Huhn, Angelika Mennecke, Peter Linz, Franz Tschunko, Nicola Kästle, Armin M Nagel, Michael Uder, Arnd Dörfler, Ralf A Linker, Tobias Engelhorn
BACKGROUND: Chronic inflammatory demyelinating diseases of the CNS typically show a limited lesion size. However, extended lesions may appear with an atypical configuration. Large lesions with a diameter>2cm accompanied by tumor-like edema are entitled "tumefactive" and may occur in multiple sclerosis (MS) and other demyelinating diseases. Historically, differential diagnosis often requires histological analysis. Therefore, advanced imaging techniques are warranted to allow for a precise non-invasive diagnosis...
August 15, 2017: Journal of the Neurological Sciences
Mahmoud Reza Ashrafi, Ali Reza Tavasoli, Houman Alizadeh, Javad Zare Noghabi, Nima Parvaneh
A tumefactive lesion of central nervous system (CNS) is defined as a mass-like lesion with a size greater than 2 cm in brain detected by magnetic resonance imaging (MRI). Neuroimaging may help to distinguish the nature of a tumefactive lesion and therefore, can prevent an unnecessary brain biopsy. Here we emphasized on determining the nature of a CNS tumefactive lesions with the help of MRI and more explanations about demyelinating lesions with focus on Schilder and Balo diseases as two multiple sclerosis variants...
2017: Iranian Journal of Child Neurology
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