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Fulminant inflammatory demyelination presenting as stroke-in-evolution in an elderly subject.

Simone Sacco¹, Ilaria Callegari², Isabella Canavero³

¹Department of Clinical Surgical Diagnostic and Pediatric Sciences, Institute of Radiology, University of Pavia, Pavia, Italy.

Brain and Behavior

|February 22, 2021

Summary

Fulminant inflammatory demyelination can mimic stroke, posing diagnostic challenges. Early immunosuppression may benefit patients with this rare condition.

Keywords:

ADEM fulminant inflammatory demyelination inflammatory demyelinating disorders tumefactive demyelinating lesions

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Area of Science:

Neurology
Neuroimmunology
Demyelinating Disorders

Background:

Inflammatory demyelinating disorders can present as fulminant demyelination.
This presentation may mimic stroke, particularly in younger individuals.

Observation:

A 67-year-old woman presented with stroke-like symptoms including rapid speech impairment and drowsiness.
Initial clinical, laboratory, and neuroimaging findings were inconclusive for a specific diagnosis.
The patient was diagnosed with extensive brain inflammatory demyelination.

Findings:

Fulminant inflammatory demyelination can present with hyperacute, stroke-like neurological deficits.
Diagnostic workup may not immediately differentiate demyelination from cerebrovascular events.
Immunosuppressive therapy led to clinical improvement in the reported case.

Implications:

Highlights the critical need to consider fulminant inflammatory demyelination in stroke mimics.
Emphasizes diagnostic challenges in differentiating demyelinating disorders from stroke.
Suggests immunosuppression as a potential treatment for severe inflammatory demyelination.