Tumefactive demyelination: updated perspectives on diagnosis and management

Area of Science:

• Neuroimmunology
• Neuropathology
• Clinical Neurology

Background:

• Tumefactive demyelination (TD) presents diagnostic challenges, often mimicking neoplastic or infectious lesions.
• Effective management requires differentiating TD from other conditions and addressing acute lesion consequences.
• Determining the underlying cause is crucial for guiding appropriate long-term treatment strategies.

Purpose of the Study:

• To review the literature on tumefactive demyelination (TD).
• To cover clinic-radiological features, association with multiple sclerosis (MS), and differential diagnosis.
• To review current and emerging treatments for TD.

Main Methods:

• Literature review of tumefactive demyelination (TD).
• Analysis of clinic-radiological features and differential diagnoses.
• Review of acute and long-term treatment strategies for TD.

Main Results:

• TD diagnosis is complex, requiring differentiation from neoplasms and infections.
• Differential diagnosis includes atypical demyelinating disorders like ADEM, MOGAD, and NMOSD.
• Treatment approaches vary based on the underlying cause of demyelination.

Conclusions:

• Accurate diagnosis of TD is essential for appropriate patient management.
• Advances in neuroimaging and biomarkers are expected to improve early and accurate TD diagnosis.
• Improved diagnostic capabilities will lead to better patient outcomes in tumefactive demyelination.