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Tumefactive demyelinating lesions: A comprehensive review.

Hussein Algahtani1, Bader Shirah2, Ali Alassiri3

  • 1King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.

Multiple Sclerosis and Related Disorders
|June 17, 2017
PubMed
Summary

Tumefactive demyelinating lesions (TDL) are rare MS variants challenging diagnosis. Current evidence suggests avoiding Fingolimod in TDL patients and highlights the need for further research into TDL etiology and management.

Keywords:
Brain tumorDemyelinating diseaseMagnetic resonance imagingMultiple sclerosisTumefactive demyelinationTumefactive multiple sclerosis

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Area of Science:

  • Neurology
  • Neuroimmunology
  • Radiology

Background:

  • Tumefactive demyelinating lesions (TDL) are rare variants of multiple sclerosis (MS).
  • TDL presents diagnostic challenges, often mimicking central nervous system (CNS) neoplasms on MRI.
  • Estimated prevalence is 1-3/1000 MS cases, potentially underestimated.

Purpose of the Study:

  • To comprehensively explore Tumefactive Demyelinating Lesions (TDL).
  • To provide an evidence-based approach for TDL diagnosis and treatment.
  • To improve diagnostic accuracy and treatment outcomes for TDL.

Main Methods:

  • Review of detailed history and physical examination findings.
  • Analysis of Magnetic Resonance Imaging (MRI) characteristics for TDL diagnosis.
  • Evaluation of current and proposed treatment strategies for TDL.

Main Results:

  • Detailed clinical and MRI data can potentially obviate the need for brain biopsy.
  • Acute TDL treatment involves corticosteroids and plasma exchange.
  • Conventional disease-modifying therapies are recommended for relapsing-remitting MS with TDL, with caution advised for Fingolimod.

Conclusions:

  • TDL diagnosis requires careful consideration due to its mimicry of other CNS lesions.
  • Fingolimod use in TDL patients is discouraged based on recent data.
  • Further multi-center research is essential to clarify TDL etiology and optimize management strategies.