Tumefactive Variant of Multiple Sclerosis –  Two Case Reports

Authors: I. Okáčová 1,2;  Y. Benešová 1;  E. Vlčková 1,2;  M. Keřkovský 2,3;  P. Praksová 1,2;  M. Hladíková 1,2;  J. Kosík 4;  D. Uldrijanová 1;  P. Štourač 1,2;  J. Bednařík 1,2
Authors‘ workplace: Neurologická klinika LF MU a FN Brno 1;  CEITEC – Středoevropský technologický institut, MU, Brno 2;  Radiologická klinika LF MU a FN Brno 3;  Neurochirurgické oddělení, Nemocnice Na Homolce, Praha 4
Published in: Cesk Slov Neurol N 2013; 76/109(5): 641-647
Category: Case Report


Diagnosis of multiple sclerosis (MS) according to the revised diagnostic criteria is based on clinical symptoms and magnetic resonance imaging (MRI). Diagnosis of MS requires elimination of more likely diagnoses. Multiple sclerosis lesions are visible on MRI as T2 hypersignal lesions typically in at least two of the four CNS areas: periventricular, juxtacortical, infratentorial and spinal cord. Tumefactive MS (TMS) is a rare variant of this disease with the estimated prevalence of about 3 cases per million people. Its radiological and clinical symptoms are different from common MS variants and could mimic other diseases, such as brain tumours and inflammatory diseases. Typical radiographic feature of TMS is defined as a solitary large lesion sized >2 cm, associated with perilesional oedema and/or the presence of ring enhancement on MR. Clinical signs and symptoms depend on lesion location and size and include headache, cognitive abnormalities, mental confusion, aphasia, apraxia and/or seizures. Since differential diagnosis of such clinical presentation and MRI is difficult, brain biopsy is often required. Diagnosis could be supported by positron emission tomography, cerebrospinal fluid examination and evoked potentials. In this report, we present two patients with tumefactive MS. The purpose of the report is to emphasize clinical and radiological features of this rare disease and to pinpoint examination procedures that could be used in differential diagnosis.

Key words:
tumefactive multiple sclerosis – magnetic resonance imaging – positron emission tomography – stereotactic brain biopsy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


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