Tumefactive multiple sclerosis which initially presented with brainstem encephalitis with a long-term follow-up

Area of Science:

• Neurology
• Neuroimmunology
• Demyelinating Diseases

Background:

• Tumefactive demyelinating lesions (TDLs) are uncommon manifestations of multiple sclerosis (MS).
• This report focuses on a unique case of tumefactive MS with an initial presentation of brainstem encephalitis.

Observation:

• The patient experienced relapses predominantly in the brainstem for two decades, followed by periventricular white matter involvement.
• Initial response to steroid treatment was favorable, with recovery.
• Long-term oral steroid use led to immunodeficiency, precluding aggressive therapies and resulting in incomplete recovery during relapses.

Findings:

• The clinical course and treatment response deviated from classical multiple sclerosis presentations.
• This case provides rare insights into the long-term outcomes of tumefactive MS.

Implications:

• Understanding atypical presentations of tumefactive MS is crucial for accurate diagnosis and management.
• The long-term effects of immunosuppression in MS require careful consideration.
• This case underscores the heterogeneity of MS and the importance of individualized treatment strategies.