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Recurrent tumefactive demyelination: An unusual presentation
Amita Bhargava1, Guruprasad S Pujar1, Basavaraj F Banakar1
1Department of Neurology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India.
Abstract:
Tumefactive multiple sclerosis (MS) is a rare variant of MS characterized by the presence of large demyelinating plaques of more than 2 cm, identified with magnetic resonance imaging (MRI). Distinguishing tumefactive lesions from other etiologies of intracranial space occupying lesions is necessary to avoid the inadvertent intervention. We had a 14-year-old girl who presented to us with two episodes of subacute hemiparesis over a span of 6 months. Her MRI brain showed large lesions, which were hyperintense on T2-weighted/flair images with incomplete ring enhancement open towards the gray matter in postgadolinium images with minimal surrounding edema and mass effect. We treated her as a case of tumefactive demyelination (TD) with steroids after which patient recovered with minimal deficits. TD occurs more commonly in women and young adults and is reported rarely. TD in a young girl with recurrence in such short span causing bilateral hemiparesis has never been reported.
Insights
Tumefactive demyelination, a rare MS variant, presents as large brain lesions. This case highlights a unique, recurrent presentation in a young girl, emphasizing diagnostic challenges.
Area of Science:
- Neurology
- Radiology
Background:
- Tumefactive multiple sclerosis (MS) is a rare demyelinating condition.
- Characterized by large lesions (>2 cm) on MRI, it mimics intracranial space-occupying lesions.
- Accurate diagnosis is crucial to prevent unnecessary interventions.
Observation:
- A 14-year-old female presented with recurrent subacute hemiparesis over 6 months.
- Brain MRI revealed large T2/FLAIR hyperintense lesions with incomplete ring enhancement.
- Minimal surrounding edema and mass effect were noted.
Findings:
- The patient was diagnosed with tumefactive demyelination (TD).
- Treatment with steroids led to recovery with minimal deficits.
- This recurrent presentation in a young girl is unprecedented.
Implications:
- Highlights the importance of considering TD in young patients with large intracranial lesions.
- Emphasizes the diagnostic challenge posed by tumefactive lesions.
- Suggests potential for recurrent TD even in young individuals.
