Transtentorial herniation from tumefactive multiple sclerosis mimicking primary brain tumor

Area of Science:

• Neurology
• Neuroimaging
• Pathology

Background:

• Multiple sclerosis (MS) is a chronic CNS inflammatory demyelinating disease.
• Lesions can mimic tumors due to size, edema, and imaging characteristics, termed tumefactive MS.
• Tumefactive MS is associated with aggressive disease progression.

Observation:

• A 50-year-old woman with MS developed transtentorial brain herniation.
• This was secondary to malignant cerebral edema from a large, ring-enhancing tumefactive MS lesion.
• The patient's condition progressed despite treatments including IV steroids, IV immunoglobulin, and plasmapheresis.

Findings:

• The tumefactive MS lesion exhibited significant mass effect and vasogenic edema.
• The edema led to increased intracranial pressure, necessitating a decompressive hemicraniectomy.
• This case underscores the potential for tumefactive MS to cause severe complications.

Implications:

• Tumefactive MS can present as a diagnostic challenge, mimicking primary brain tumors.
• The significant mass effect from these lesions can lead to life-threatening complications like brain herniation.
• Early recognition and management are crucial for patients with tumefactive MS.