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09:41
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Tumefactive demyelination-to cracks the nut without cracking the pot
C Rajasekharan1, V Anto, R Unnikrishnan
1Department of Internal Medicine, Medical College Hospital, Thiruvanthapuram, Kerala, India. drcrajasekharan@yahoo.com
BMJ Case Reports
|May 19, 2012
Summary
A rare brain lesion in the corpus callosum, initially suspected as glioma or lymphoma, responded dramatically to steroid treatment in a diabetic patient. This case highlights steroids as a potential treatment for certain corpus callosum lesions.
Area of Science:
- Neuroscience
- Radiology
- Oncology
Background:
- The corpus callosum is crucial for interhemispheric communication.
- Lesions in this area can cause diverse and severe neurological deficits.
- Differential diagnosis for corpus callosum lesions includes tumors, inflammatory conditions, and infections.
Observation:
- A 45-year-old diabetic female presented with progressive gait difficulty, cognitive changes, and incontinence.
- Clinical examination revealed facial nerve palsy and ataxia.
- Brain imaging showed a hyperdense lesion in the corpus callosum, with MRI revealing T2-hyperintense lesions with restricted diffusion.
Findings:
- Initial differential diagnoses included infiltrative glioma, demyelination, and CNS lymphoma.
- Due to patient and family refusal of biopsy, empiric steroid treatment was initiated.
- Neurological deficits resolved, and repeat MRI demonstrated significant lesion reduction, suggesting a steroid-responsive etiology.
Implications:
- This case suggests that steroid-responsive inflammatory or demyelinating processes should be considered in the differential diagnosis of corpus callosum lesions, even with initial imaging suggestive of malignancy.
- Prompt diagnosis and treatment, even without biopsy, can lead to significant recovery.
- Further research into non-invasive diagnostic methods and treatment protocols for corpus callosum lesions is warranted.
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