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Tumefactive Multiple Sclerosis presenting as Acute Ischemic Stroke

Hussam A Yacoub1, Zaid A Al-Qudahl, Huey-Jen Lee

  • 1Department of Radiology, UMDNJ-New Jersey Medical School, Newark, NJ.

Journal of Vascular and Interventional Neurology
|April 21, 2012
PubMed
Abstract

Insights

Tumefactive multiple sclerosis (MS) can mimic other brain conditions. A brain biopsy confirmed MS in a patient misdiagnosed with stroke, highlighting its importance in challenging cases.

Area of Science:

  • Neurology
  • Radiology
  • Pathology

Background:

  • Multiple sclerosis (MS) lesions are typically small, homogenous ovoid lesions on MRI.
  • Atypical MS lesions can present with features like large size, mass effect, and edema.
  • Tumefactive MS lesions radiographically resemble neoplasms, infarction, and infections.

Purpose of the Study:

  • To present a case of tumefactive demyelinating lesion misdiagnosed as ischemic stroke.
  • To highlight the diagnostic challenges and the role of brain biopsy in tumefactive MS.

Main Methods:

  • Case report of a 43-year-old woman with right-gaze preference and left-sided weakness.
  • Diagnostic workup included laboratory tests, contrast-enhanced MRI, cerebrospinal fluid analysis, and magnetic resonance spectroscopy (MRS).
  • Brain biopsy was performed for definitive diagnosis.

Main Results:

  • MRI revealed FLAIR hyperintensity and restricted diffusion in the right frontal lobe.
  • MRS showed elevated choline/creatine, increased lactate, and normal NAA/creatine ratios.
  • Brain biopsy confirmed demyelination with axonal preservation and T-cell infiltration, indicative of active MS.

Conclusions:

  • Tumefactive MS can be misdiagnosed as stroke, infection, or tumor.
  • Brain biopsy is crucial for diagnosing atypical or challenging cases of tumefactive MS.
Keywords:
demyelinationmultiple sclerosisstroketumefactivetumor

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