Tumefactive Multiple Sclerosis: Case Report and Review of the Literature

Abstract

Scientific background: Tumefactive multiple sclerosis (MS) is a rare variant ofb MS. It has been reported that this disorder characterized by large, demiyelinating lesions has displayed a monophasic course or subsequently it could develop into typical MS. However, in some patients with MS, tumefactive demiyelinating lesions could be encountered during the course of the disease. In such cases, other demiyelinating disease, MS variants, primary central nervous system vasculitis, glioma or other neoplasms should also be taken into consideration in differential diagnosis. In the diagnosis of such large lesions, physiologic magnetic resonance imaging (MRI) investigations have also been recommended as an alternative to brain biopsy in recent years. Although the disease has been reported to display an aggressive course in some limited MS cases in whom new-onset attack characterized by tumefactive lesion is present, the effect of these large lesions on the prognosis of MS patients have not conclusively been identified. Objective: To report the case of a forty-year-old female whose tumefactive MS plaque has been identified in the acute attack characterized by behavior and personality changes with a diagnosis of relapsing-remitting MS (RRMS) and compare the obtained data with the literature findings. Material and methods: Routine neurological examination and biochemical investigations, infectious and collagen vascular disease tests, evoked potential studies, cerebrospinal fluid examination, oligoclonal band analysis, conventional MRI and diffusion weighted MRI methods were performed. Results: Tumefactive demiyelinating lesion has been identified in a case with a diagnosis of RRMS and, radiological and clinical improvement was observed by means of pulse steroid treatment. Conclusions: Tumefactive lesions may develop in typical RRMS cases during the course of the disease and physiologic MRI methods have been observed to be useful in the diagnosis of these lesions. Contrary to the limited literature findings, the relatively good prognosis identified in the present case with such a lesion has been found to be significant. The clinical significance of these large plaques should be revealed through more comprehensive studies to be conducted.