Summary
A 13-year-old female presented with two episodes of hemiplegia and hemianopia involving
opposite sides, each time associated with seizures. On both occasions, the magnetic
resonance (MR) scan showed a giant demyelinating, peripherally enhancing lesion with
mass effect. MR spectroscopy (MRS) was indistinguishable from a tumor. At the first
episode, she had undergone tumor decompression but the histopathology revealed an
acute demyelinating lesion with no evidence of tumor. Each time there was partial
clinical recovery and resolution of the radiological lesion, the patient having received
corticosteroids during both of the episodes. She also developed hemiballismus postoperatively
which resolved on withdrawing phenytoin. It is suggested that a trial of corticosteroids
be given in suspected tumefactive demyelinating lesions, although they may be indistinguishable
from a tumor.
Keywords
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References
- Multiple sclerosis in childhood: clinical features of 149 cases.Mult. Scler. 1997; 3: 43-46
- Epidemiology of multiple sclerosis: a critical overview.Can. J. Neurol. Sci. 1993; 20: 17-29
- A case of multiple sclerosis with multi-ring-like and butterfly-like enhancement on computerized tomography.Brain Dev. 1985; 7: 43-45
- Multiple sclerosis plaque simulating cerebral tumor: case report and review of the literature.Neurosurgery. 1987; 21: 244-246
- Multiple sclerosis mimicking primary brain tumor.Arch. Pathol. Lab. Med. 1987; 111: 464-468
- Multiple sclerosis simulating brain tumor on computed tomography.J. Comput. Assist. Tomogr. 1989; 13: 674-678
- CT ring sign imitating tumour, disclosed as multiple sclerosis by MRI: a case report.J. Neurol. Neurosurg. Psychiatry. 1989; 52: 903-906
- Physiologic MRI of a tumefactive multiple sclerosis lesion.Neurology. 1998; 51: 1486-1488
- MR imaging of multiple sclerosis simulating brain tumor.Clin. Imag. 1996; 20: 171-177
- Multiple sclerosis and brain tumor: a diagnostic challenge.J. Emerg. Med. 1989; 7: 241-244
- Concurrence of multiple sclerosis and brain tumor: clinical considerations.Neurology. 1997; 48: 1330-1333
- Multiple sclerosis masquerading as a mass lesion.Neuroradiology. 1992; 34: 150-154
- Effect of brain irradiation on demyelinating lesions.Neurology. 1993; 43: 2105-2112
- Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients.Ann. Neurol. 1993; 33: 18-27
- Tumoral multiple sclerosis of the cerebellum in a child.Am. J. Neuroradiol. 1995; 16: 1164-1166
- Tumefactive demyelinating lesions.Neuroradiology. 1996; 38: 560-565
Case records of the Massachusetts General Hospital. Weekly clinico-pathological excersises. Case 26-1998. A 15 years old girl with hemiparesis, slurred speech and an intracranial lesion (clinical conference). N Eng J Med 1998; 339: 542–549
- Focal plaque of demyelination mimicking cerebral tumor in a pediatric patient.Pediatr. Neurosurg. 1998; 29: 60-63
- Pediatric tumefactive demyelination: case series and review of the literature.Pediatr. Neurol. 2002; 26: 18-25
- Bilateral demyelinating tumefactive lesions in three children with hemiparesis.J. Child Neurol. 2002; 17: 655-660
- Conventional MRI and magnetisation transfer imaging of tumour-like multiple sclerosis in a child.Neuroradiology. 2002; 44: 97-99
- Demyelinating diseases.in: Graham D.I. Lantos P.L. Greenfield’s Neuropatholgoy. seventh edn. Edward Arnold, London2002: 471-550
- Multiple Sclerosis in children.Brain Dev. 2003; 25: 229-232
- MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT.Neurology. 1988; 38: 180-185
- Criteria for an increased specificity of MRI interpretation in elderly subjects with suspected multiple sclerosis.Neurology. 1988; 38: 1822-1825
- Multiple sclerosis: the impact of MR imaging.Am. J. Roentgenol. 1992; 158: 849-857
- Abnormal corpus callosum: a sensitive and specific indicator of multiple sclerosis.Radiology. 1991; 180: 215-221
- Antemortem diagnosis of Balo concentric sclerosis: correlative MR imaging and pathologic features.Radiology. 1994; 191: 817-819
- A case of myelinoclastic diffuse sclerosis in an adult.Neurology. 1991; 41: 316-318
- Myelinoclastic diffuse sclerosis (Schilder’s disease): cliniconeuroradiologic correlations.Neurology. 1991; 41: 589-591
- Acquired inflammatory white matter diseases.Child Nerv. Syst. 2001; 17: 202-210
- Magnetic resonance imaging in five patients with a tumefactive demyelinating lesion in the central nervous system.Arq. Neuropsiquiatr. 1999; 57: 921-926
- Demyelinating disease of corpus callosum presenting as glioma on magnetic resonance scan: a case documented with pathological findings.Neurosurgery. 1987; 21: 247-250
- Demyelinating disease versus tumor in surgical neuropathology. Clues to a correct pathological diagnosis.Am. J. Surg. Pathol. 1993; 17: 537-545
- Coincidence of multiple sclerosis and glioma. Clinical and radiological remarks on two cases.Surg. Neurol. 1986; 26: 45-51
- Proton magnetic resonance spectroscopy in a pathologically confirmed acute demyelinating lesion.J. Neurol. 1997; 244: 204-207
- Serial proton magnetic resonance spectroscopy in acute multiple sclerosis lesions.Brain. 1994; 117: 49-58
- Spectroscopic magnetic resonance imaging of a tumefactive demyelinating lesion.Neuroradiology. 2002; 44: 986-989
- Proton MR spectroscopy of tumefactive demyelinating lesions.Am. J. Neuroradiol. 2002; 23: 1378-1386
- Anticonvulsant-induced dyskinesias: a comparison with dyskinesias induced by neuroleptics.J. Neurol. Neurosurg. Psychiatry. 1976; 39: 1210-1218
- Phenytoin and dyskinesias: a report of two cases and review of the literature.Mov. Disord. 1993; 8: 19-27
Article info
Publication history
Accepted:
July 2,
2004
Received:
December 28,
2003
Identification
Copyright
© 2004 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
