Tumefactive demyelinating lesions of 15 patients: Clinico-radiological features, management and review of the literature

J Neurol Sci. 2017 Oct 15;381:32-38. doi: 10.1016/j.jns.2017.08.005. Epub 2017 Aug 12.

Abstract

Background and objective: Tumefactive demyelinating lesions (TDLs) are large inflammatory lesions that can mimic tumors or other space-occupying lesions. Differential diagnosis and management of these lesions remain challenging for neurologists. We aim to review the clinico-radiological features of patients with TDLs, as well as their management.

Methods: We performed a retrospective review of cases of TDLs treated in our center from January 2010 to February 2017. We reviewed the literature.

Results: Out of 711 patients, we found 15 with TDLs (12 women and 3 men), with a mean age of TDL onset of 36years. Out of the 15 patients, 9 had TDLs as a first demyelinating event and 44% (4/15) of these converted to MS by McDonald 2010 criteria in a mean time of 8months (SD 3.10). Clinical presentation was polysymptomatic and the most common radiological findings included solitary lesions (66.66%), located primarily in the frontal (40%) or parietal (33%) lobes, showing mostly an infiltrative morphological pattern (50%) and an open-ring enhancement (43%). Multiple Sclerosis was the most common diagnosis (67%, 10/15). Acute treatment included steroids, plasmapheresis, rituximab and cyclophosphamide.

Conclusions: Prevalence of tumefactive demyelination in MS was higher than expected in MS patients, according to literature. Time to conversion to MS was significantly shorter than other published series. Clinical presentation was polysymptomatic and the most common radiological findings were isolated frontal lesions with an open-ring enhancement.

Publication types

  • Review

MeSH terms

  • Adult
  • Brain / diagnostic imaging
  • Brain / pathology
  • Demyelinating Diseases / diagnosis*
  • Demyelinating Diseases / physiopathology
  • Demyelinating Diseases / therapy*
  • Diagnosis, Differential
  • Disease Management
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuroimaging
  • Retrospective Studies
  • Young Adult