Tumefactive Demyelinating Lesions and Pregnancy.

Area of Science:

• Neurology
• Neuroimmunology
• Radiology

Background:

• Tumefactive demyelinating lesions (TDLs) are rare, large demyelinating lesions.
• Only one case of gestational TDL has been previously reported.
• Pregnancy and postpartum periods are associated with neurological changes.

Observation:

• Two cases of TDLs are described, one during early pregnancy and another postpartum.
• The first case involved a pregnant woman with a subcortical TDL and deep vein thrombosis.
• The second case involved a woman with multiple sclerosis and rheumatoid arthritis presenting with a TDL eight months postpartum.

Findings:

• Brain biopsy of the first TDL revealed subacute demyelination with macrophages and inflammation.
• Both TDLs occurred in prothrombotic conditions, suggesting a role for thromboinflammation.
• The postpartum TDL showed partial reduction after steroid therapy.

Implications:

• These cases suggest TDLs can occur during and after pregnancy, expanding the known spectrum of gestational neurological events.
• The association with prothrombotic states points to thromboinflammation as a potential mechanism in TDL development.
• Further research is warranted to explore the relationship between pregnancy, prothrombotic states, and TDLs in women with and without multiple sclerosis.