Conventional MRI and magnetisation transfer imaging of tumour-like multiple sclerosis in a child.

Department of Radiology, Medical School, University of Ioannina, Greece.
Neuroradiology (Impact Factor: 2.7). 02/2002; 44(1):97-9. DOI: 10.1007/s002340100704
Source: PubMed

ABSTRACT Tumefactive multiple sclerosis is a rare entity in children. Differential diagnosis includes other mass lesions such as neoplasm and abscess. A case of tumefactive multiple sclerosis in a child is presented. The open-ring pattern of enhancement on conventional MRI and magnetisation transfer imaging was important for the initial diagnosis and the evaluation of the course of the disease.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Tumefactive demyelinating lesions (TDLs) are misdiagnosed frequently. To investigate the characteristics of TDLs, clinical and radiological data from nine cases with TDLs were analyzed after admission. All cases underwent surgery and pathological examination; some received postoperative steroid therapy. Onsets were mostly within 3 weeks and main presentation included intracranial hypertension, extremity weakness, epilepsy, and visual disturbance. Symptoms in children were acute and severe, frequently including headache, vomiting, and visual disturbance. Most intracephalic lesions were in cerebral hemispheres. All intraspinal lesions were in cervical segments. Radiological features included mass effect, perifocal edema and enhancement (of which open-ring enhancement was diagnostic), and decreased relative cerebral blood volume. Intraoperative frozen section did not confirm the diagnosis, while postoperative paraffin section did confirm it (by evidence of macrophage infiltration). The patients responded well to steroid therapy and no relapse was found during following up. Thus, intensive analysis of both clinical and radiological data may provide some clues for diagnosis. For suspected cases, it is advisable to take steroid therapy or undergo advanced radiological examinations, such as serial magnetic resonance spectroscopy. However, in difficult cases, pathological evidence is beneficial to a final diagnosis.
    Neurosurgical Review 02/2009; 32(2):171-9; discussion 179. · 1.97 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Tumefactive demyelinating disease (TDD) is a rare demyelinating disease—probably a variant of multiple sclerosis (MS)—presenting as a focal cerebral mass. Clinically and radiographically, TDD is usually difficult to differentiate from tumor and abscess. Magnetic resonance imaging (MRI) characteristically shows a large lesion—contrast enhancement often like an incomplete ring—with relatively limited mass effect and surrounding edema. Findings on “non-conventional” MRI, multifocality on MRI of the whole central nervous system (CNS), monitoring of visual evoked potentials, and cerebrospinal fluid analysis may all contribute to the differential diagnosis. In analogy with the recommendations for acute MS exacerbations, acute disseminated encephalomyelitis and other forms of acute conditions with severe inflammatory CNS demyelination, high-dose corticosteroid treatment is regarded as first-line therapy. A rapid and pronounced clinical and radiological response to the administration of high-dose corticosteroids is often observed and may alleviate the need for cerebral biopsy. In agreement with the recommendations for other conditions characterized by acute CNS demyelination, plasma exchange is considered to be second-line therapy. In patients who do not respond to non-surgical therapy and who exhibit a pronounced cerebral mass lesion and clinical signs of increased intracranial pressure (ICP), decompressive craniectomy including wide opening of the dura is recommended.
    European Neurological Journal. 01/2010;
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Multiple sclerosis (MS) with initial neuroradiological features suggestive of brain tumour (tumour-like MS) may represent a challenging diagnosis. METHODS: Among the patients seen at the MS centre of our Institution between 2000 and 2010, we identified cases presenting with a large (diameter>2cm), well-defined lesion, suggestive of brain tumour on initial brain magnetic resonance imaging (MRI). Only patients with at least 10years follow-up were included. RESULTS: Five young women with MS who presented with a tumour-like lesion on initial brain MRI are described. All cases presented with sudden-onset neurological deficits due to a single large brain lesion compatible with neoplasm at MRI. Two cases underwent brain stereotactic biopsy, both misdiagnosed as astrocytoma. However, the subsequent clinical and MRI follow-up was consistent with MS in all cases. Unnecessary surgery and radiotherapy were responsible for disability in two cases. In three cases, the course of the disease remains benign after more than 13years from symptoms onset. CONCLUSIONS: Our report of clinical, radiological and pathological features of five tumour-like MS cases confirms that it is mandatory to consider a demyelinating process in the differential diagnosis of tumour-like brain lesions. Many tumour-like MS cases may have a favourable long term prognosis.
    Journal of the neurological sciences 11/2012; · 2.32 Impact Factor