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Journal of Medical Case Reports

, 6:104

First Online: 06 April 2012Received: 04 November 2011Accepted: 06 April 2012DOI: 10.1186-1752-1947-6-104

Cite this article as: Yamada, S., Yamada, S.M., Nakaguchi, H. et al. J Med Case Reports 2012 6: 104. doi:10.1186-1752-1947-6-104

Abstract

IntroductionTumefactive multiple sclerosis is a demyelinating disease that demonstrates tumor-like features on magnetic resonance imaging. Although diagnostic challenges without biopsy have been tried by employing radiological studies and cerebrospinal fluid examinations, histological investigation is still necessary for certain diagnosis in some complicated cases.

Case presentationA 37-year-old Asian man complaining of mild left leg motor weakness visited our clinic. Magnetic resonance imaging demonstrated high-signal lesions in bilateral occipital forceps majors, the left caudate head, and the left semicentral ovale on fluid-attenuated inversion recovery and T2-weighted imaging, and these lesions were enhanced by gadolinium-dimeglumin. Tumefactive multiple sclerosis was suspected because the enhancement indistinctly extended along the corpus callosum on magnetic resonance imaging and scintigraphy showed a low malignancy of the lesions. But oligoclonal bands were not detected in cerebrospinal fluid. In a few days, his symptoms fulminantly deteriorated with mental confusion and left hemiparesis, and steroid pulse therapy was performed. In spite of the treatment, follow-up magnetic resonance imaging showed enlargement of the lesions. Therefore, emergent biopsy was performed and finally led to the diagnosis of demyelinating disease. The enhanced lesion on magnetic resonance imaging disappeared after one month of prednisolone treatment, but mild disorientation and left hemiparesis remained as sequelae.

ConclusionsFulminant aggravation of the disease can cause irreversible neurological deficits. Thus, an early decision to perform a biopsy is necessary for exact diagnosis and appropriate treatment if radiological studies and cerebrospinal fluid examinations cannot rule out the possibility of brain tumors.

AbbreviationsCDcluster of differentiation

CSFcerebrospinal fluid

MRCMedical Research Council

MRSmagnetic resonance spectroscopy

MRImagnetic resonance imaging

PETpositron emission tomography

tMStumefactive multiple sclerosis.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-6-104 contains supplementary material, which is available to authorized users.

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Autor: So Yamada - Shoko Merrit Yamada - Hiroshi Nakaguchi - Mineko Murakami - Katsumi Hoya - Akira Matsuno - Kazuto Yamazaki - Y

Fuente: https://link.springer.com/







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