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Tumefactive Multiple Sclerosis: Challenges With Treatment Modalities.

Jude ElSaygh¹, Nicole Kandinova¹, Anas Zaher¹

¹Internal Medicine, NewYork Presbyterian - Brooklyn Methodist Hospital, New York, USA.

|August 14, 2023

Summary

Tumefactive multiple sclerosis, a rare condition, presents diagnostic challenges due to large lesions mimicking brain tumors. This case highlights atypical progression despite treatment, emphasizing unique diagnostic and management considerations.

Keywords:

diagnosis of multiple sclerosis high-dose corticosteroids intravenous immunoglobulins (ivig)multiple sclerosis flare-up tumefactive sclerosis

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Area of Science:

Neuroimmunology
Neurology
Radiology

Background:

Tumefactive multiple sclerosis (TOMS) is a rare variant of multiple sclerosis (MS).
TOMS lesions are typically large (>2 cm) and solitary, often presenting with significant vasogenic edema.
These characteristics frequently lead to misdiagnosis as primary intracranial malignancy.

Observation:

A 25-year-old female presented with homonymous superior quadrantanopia.
Brain MRI revealed a large left temporal lesion with marked edema.
Diagnosis was confirmed as tumefactive multiple sclerosis.

Findings:

The patient received intravenous immunoglobulin (IVIg) due to concerns for superimposed infection.
Paradoxical symptom progression and lesion expansion were observed on repeat MRI.
This case underscores atypical responses to treatment in TOMS.

Implications:

Highlights the diagnostic complexities of tumefactive multiple sclerosis.
Suggests the need for careful monitoring and consideration of atypical presentations.
Emphasizes potential differences in management strategies compared to typical MS or other space-occupying lesions.