Elsevier

World Neurosurgery

Volume 112, April 2018, Pages 37-38
World Neurosurgery

Clinical Images
Tumefactive Multiple Sclerosis Masquerading as High Grade Glioma

https://doi.org/10.1016/j.wneu.2018.01.013Get rights and content

Tumefactive multiple sclerosis is a demyelinating lesion that can radiographically mimic high-grade gliomas during acute episodes, thus affecting clinical decision making. A delay in appropriate diagnoses can result in unnecessary invasive resections. The following case is a patient with unilateral weakness and radiologic findings that were concerning for a high-grade glioma. Peripheral studies were equivocal. The decision was made to proceed with a stereotactic biopsy, yielding a definitive diagnosis of tumefactive demyelinating lesion (TDL). The patient responded robustly to medical management and made a full clinical recovery. While TDLs and gliomas may look radiologically identical during acute demyelinating episodes, unlike gliomas, TDLs will demonstrate evolvement over serial imaging and robust clinical response to high dose steroids. Clinicians should proceed with caution when considering invasive procedures with such lesions. Conservative medical management is often sufficient as seen in this patient. This case highlights the importance of timely diagnosis and management of TDLs.

References (2)

  • A. Altintas et al.

    Clinical and radiological characteristics of tumefactive demyelinating lesions: follow-up study

    Mult Scler

    (2012)
  • C.F. Lucchinetti et al.

    Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis

    Brain

    (2008)

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

View full text