Abstract

Demyelinating lesions larger than 2 cm in diameter, with or without edema, are known as tumefactive demyelinating lesions (TDLs). They constitute a rare inflammatory demyelinating disorder of the central nervous system. TDLs are typically characterized by headaches, cortical symptoms such as aphasia, hemiparesis, hemisensory deficits, seizures, and changes in consciousness. TDLs may occur in patients with or without an established diagnosis of MS or may occur as the initial demyelinating event. They may also be observed during follow-up in patients with MS, neuromyelitis optica, acute disseminated encephalomyelitis, or other autoimmune diseases. Differential diagnosis includes brain tumors, abscess, granulomatous diseases, and vasculitis. In some cases, it may be very difficult to distinguish TDLs from a tumor, such that biopsy might be needed. However, no cases of asymptomatic TDLs have yet been reported in the literature. Hence, in this report, we present a case involving an asymptomatic TDL detected incidentally during magnetic resonance imaging in an 18-year-old man. The patient did not develop any symptoms during the 1-year follow-up period. During follow-up, the patient was diagnosed with a radiologically isolated syndrome. TDLs have not previously been identified as radiologically isolated syndrome. Thus, reporting similar cases in the future will help in further understanding this phenomenon.

Highlights

  • A tumefactive demyelinating lesion (TDL) is an inflammatory demyelinating disorder of the central nervous system (CNS), which may occur in patients with or without an established diagnosis of multiple sclerosis (MS)

  • TDLs in clinically isolated syndrome (CIS) and MS cases typically occur during the first demyelinating attack in most patients

  • TDLs associated with treatment with fingolimod and natalizumab treatment have been reported in patients with MS

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Summary

Introduction

A tumefactive demyelinating lesion (TDL) is an inflammatory demyelinating disorder of the central nervous system (CNS), which may occur in patients with or without an established diagnosis of multiple sclerosis (MS). TDLs are defined as tumor-like demyelinating lesions larger than 2 cm, with or without surrounding edema, mass effect, and ring enhancement. These lesions are often found in the supratentorial region, most commonly in the frontal and parietal lobes. Magnetic resonance imaging (MRI) findings of TDLs include mass effect, edema, T2 hypointense rim, T1 hypointensity, contrast enhancement with gadolinium (exhibiting homogenous, heterogeneous, nodular, punctate, or open/closed ring patterns), and peripheral restriction around the lesion on diffusion-weighted images (DWI). The mean relative cerebral blood volume in patients with TDLs is less than that of brain tumors This technique cannot distinguish primary CNS lymphoma [3].

Case Reports in Neurological Medicine
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