Tumefactive demyelinating lesions (TDLs): A case series of clinicoradiological features

Clin Neurol Neurosurg. 2017 Nov;162:91-94. doi: 10.1016/j.clineuro.2017.09.013. Epub 2017 Sep 29.

Abstract

Objective: Diagnosis of tumefactive demyelination lesions (TDLs) is challenging to neurophysician, neuroradiologist or neurosurgeon. Our objective in this study was to analyze clinicoradiological features of TDLs.

Patients and method: A retrospective analysis with prospective follow-up of 11 cases of TDLs was performed. Study was conducted in the neurology department of a tertiary care centre of North-West India from August 2014 to March 2017. MRI of brain and cervical spine with contrast, visual evoked potential, oligoclonal bands, serum anti-AQP4 antibody and MRS performed in most of the patients.

Results: Mean age of tumefactive demyelinating lesions was 19.63 years (10-41) with male preponderance (M: F=1.4) and one of the patients was in a pediatric age group. Relapsing and demyelinating courses of disease, seizure and incomplete ring enhancement were found in 6 out of 11(54.5%), 4 out of 11 (36.3%) 3 out of 11(27.2) respectively. OCBs were positive in 4 out of 5 patients (80%).

Conclusion: Recognition of atypical presentation or clinicoradiological features would aid in diagnosis along with visual evoked potential, oligoclonal bands and responsiveness to steroids may obviate the need for invasive procedure like brain biopsy.

Keywords: Anarthria; Incomplete ring enhancement; Mitoxantrone; Oligoclonal bands; Tumefactive demyelinating lesion (TDL).

MeSH terms

  • Adolescent
  • Adult
  • Aquaporin 4 / immunology*
  • Autoantibodies / blood
  • Child
  • Demyelinating Diseases / blood*
  • Demyelinating Diseases / diagnostic imaging*
  • Demyelinating Diseases / physiopathology*
  • Disease Progression*
  • Evoked Potentials, Visual / physiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Magnetic Resonance Spectroscopy / methods
  • Male
  • Oligoclonal Bands / blood*
  • Retrospective Studies
  • Young Adult

Substances

  • AQP4 protein, human
  • Aquaporin 4
  • Autoantibodies
  • Oligoclonal Bands