Article type: Case Report
Article title: Management of recurrent tumefactive multiple sclerosis: case report and literature review
Journal: Asian Journal of Neurosurgery
Year: 2018
Authors:
Jamir Pitton Rissardo, Ana LetÃcia Fornari Caprara
E-mail:
jamirrissardo@gmail.com
ABSTRACT
Tumefactive multiple sclerosis (MS) is characterized
by the presence of a single MS‑plaque
in the brain. It mimics tumors due to large size, mass effect, and enhancement
patterns. Refractory intracranial hypertension due to tumefactive MS requiring
decompressive craniectomy (DC) was reported in five cases. However, none of
these cases were documented new lesions during the follow‑up. We report a case of a 28‑year‑old
female admitted with acute right hemiparesis, headache, and nausea. A brain
magnetic resonance imaging (MRI) revealed a left parietal lobe lesion. Within 4
days, she became comatose. A computed tomography (CT) scan revealed the left
uncal herniation. DC and resection of the lesion were carried out.
Histopathology revealed the active demyelinating disease. After 11 years of the
first attack, she went to the emergency department due to headaches and left
hemiparesis. A head CT scan revealed a hypodense area in the right frontal
lobe. Three months later, the patient was asymptomatic, and a new MRI did not
show new lesions.
Keywords: Decompressive craniectomy, pseudotumoral multiple sclerosis, tumefactive multiple sclerosis.
Full text available at:
DOI
10.4103/ajns.AJNS_94_18
Citation
Rissardo JP, Caprara AL. Management of recurrent tumefactive multiple sclerosis: case report and literature review. Asian
J Neurosurg 2018;13:893-6.
Figure 1. Neuroimage is showing tumefactive demyelinating area. Axial (a), coronal (b), and sagittal (c) view of noncontrast head computed tomography scan showing a hypodense area in the right frontal lobe, with mass effect and subfalcine herniation. Axial T1-weighted (d), Coronal T2-weighted (e and f), Axial diffusion-weighted (g), Axial (h), and sagittal (i and j) Fluid-attenuated inversion recovery. Axial contrast showing "C"-shaped ring enhancement (k). The magnetic resonance imaging images show the left parietal lobe where there is a residual lesion from the first attack (d, f, g-j); and the right frontal lobe, with the second new lesion (d, e, g-i, k).
Table 1. Reported cases of tumefactive (pseudotumoral) multiple sclerosis requiring emergency decompressive craniectomy.