Related Experiment Video

Updated: May 3, 2026

Experimental Demyelination and Remyelination of Murine Spinal Cord by Focal Injection of Lysolecithin

Experimental Demyelination and Remyelination of Murine Spinal Cord by Focal Injection of Lysolecithin

Published on: March 26, 2015

Tumefactive demyelinating lesions in children

Ayberk Selek¹, Rahsan Göcmen², Ceren Günbey¹

¹Hacettepe University, Departmant of Child Neurology, Turkey.

European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society

|March 19, 2025

Abstract:

Tumefactive lesions (TDL) are larger than 2 cm in diameter on T2-weighted brain MRI. They are distinguished from other types of demyelinating lesions by their size and degree of perilesional edema and/or rim enhancement, which can make diagnosis challenging.

Aim:

To study the clinical and radiological features, follow-up and final diagnosis of patients presenting with TDL.

Method:

Medical records of children seen at the Pediatric neurology and radiology department between 1992 and 2017 were reviewed. 15 patients younger than 18 years of age who had at least one TDL on their first magnetic resonance imaging (MRI) were included. Clinical and radiological features and evolution of imaging findings were studied.

Results:

First, all patients were admitted acutely with a polysymptomatic presentations (86,6 %) mainly affecting the motor system (92,8 %). The largest diagnostic group was MS (n = 10, 66,6 %) with 9 out of 10 individual's diagnosed during follow up. At least one new clinical or radiological relapse was observed in 12 patients with a mean occurrence of 9 and 14 months respectively. All cases who developed a radiological relapse and most (n: 9, 75 %) of those who experienced a clinical relapse were diagnosed with MS and all had new lesions at the time of diagnosis. All children with MS had positive OCBs. Most TDLs (21/24, 87,5 %) were localized in the supratentorial area. TDL + other demyelinating lesions were observed in most 12/15 (80 %) patients and the size of TDL was between 2 and 4 cm (20/24, 83.3 %). All patients with MS, whether they had a single TDL or multiple TDLs, had accompanying small demyelinating lesions. On follow-up all TDLs became smaller (14/15, 93,3 %) or resolved (n = 1).

Conclusion:

The non-infiltratind pattern, presence of multiple small demyelinating lesions and CSF oligoclonal band positivity may suggest MS, which is one of the most common causes. However, for a definitive diagnosis, patients should continue to be monitored with radiological imaging even in the absence of clinical relapses.

Insights

Tumefactive demyelinating lesions (TDL) in children often present with motor symptoms and can be challenging to diagnose. Multiple TDLs and positive oligoclonal bands suggest Multiple Sclerosis (MS), requiring continued radiological monitoring for definitive diagnosis.

Area of Science:

Pediatric Neurology
Neuroimaging
Demyelinating Diseases

Background:

Tumefactive demyelinating lesions (TDL) are large ( >2 cm) brain lesions on MRI.
Their size and imaging characteristics can mimic other pathologies, complicating diagnosis.

Purpose of the Study:

To investigate the clinical and radiological features of TDL in children.
To analyze follow-up data and determine final diagnoses in pediatric patients with TDL.

Main Methods:

Retrospective review of medical records (1992-2017) of pediatric patients (<18 years) with TDL on initial MRI.
Analysis of clinical presentations, radiological findings, and imaging evolution.

Main Results:

Most pediatric patients presented with acute, polysymptomatic neurological deficits, primarily motor.
Multiple Sclerosis (MS) was the most common diagnosis (66.6%), with 90% diagnosed during follow-up.
TDLs often occurred with other demyelinating lesions (80%), predominantly supratentorially, and typically resolved or reduced in size over time.

Conclusions:

The presence of multiple TDLs, accompanying small demyelinating lesions, and positive cerebrospinal fluid (CSF) oligoclonal bands may indicate MS in children.
Continued radiological monitoring is crucial for definitive MS diagnosis, even without clinical relapses.

Read full analysis

Keywords:

Childhood Demyelinating Multiple sclerosis Tumefactive

More Related Videos

Comprehensive Autopsy Program for Individuals with Multiple Sclerosis

Comprehensive Autopsy Program for Individuals with Multiple Sclerosis

Published on: July 19, 2019

Label-Free Non-Linear Optics for the Study of Tubulin-Dependent Defects in Central Myelin

Label-Free Non-Linear Optics for the Study of Tubulin-Dependent Defects in Central Myelin

Published on: March 24, 2023

Related Concept Videos

Encephalitis l: Introduction

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...

Encephalitis ll: Pathophysiology

Encephalitis ll: Pathophysiology

Encephalitis is inflammation of the brain parenchyma caused by direct viral invasion or immune-mediated mechanisms triggered by infections or tumors. Both processes lead to neuronal injury, disrupted neurotransmission, and diverse neurological symptoms, often with overlapping clinical and pathological features.Autoimmune EncephalitisIn autoimmune encephalitis, antibodies target neuronal antigens on cell surfaces, synapses, or within neurons. A key example is anti-NMDAR encephalitis, which can...

Multiple Sclerosis l: Introduction

Multiple Sclerosis l: Introduction

Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...

Articles linked to this work by shared authors, journal, and citation graph.

Giardia duodenalis Infection and Pachymeningitis in a Patient With Agammaglobulinemia.

Clinical pediatrics·2026

Successful Therapy of CNS Tuberculosis With Granulomatous Inflammation in Immunodeficiency.

Clinical pediatrics·2026

Uncommon but consequential: remote cerebral and cerebellar hematomas, and pseudohypoxic brain swelling following epilepsy surgery.

Clinical neurology and neurosurgery·2026

Multinodular and Vacuolating Neuronal Tumor in a Pediatric Patient with Klinefelter Syndrome and 5q33.1 Deletion: A Rare Clinical and Genetic Case Study.

Molecular syndromology·2026

Theory of mind, empathy, and alexithymia in adolescents with systemic lupus erythematosus: associations with fatigue and internalizing symptoms.

Clinical rheumatology·2026

A novel de novo CACNA1G variant p.(Arg1553Gln) associated with neurodevelopmental delay and cerebellar hypoplasia: Expanding the phenotypic spectrum.

European journal of medical genetics·2026

See all related articles