SHM Converge Scientific Abstract ePoster Gallery-A Case of Tumefactive Multiple Sclerosis, a Rare Diagnostic Challenge

Pdf Summary

This case report describes tumefactive multiple sclerosis (MS), a rare demyelinating disorder that can closely mimic brain tumors, infections, or stroke on imaging, making diagnosis difficult.<br /><br />The patient was a 59-year-old woman with a history of uterine fibroids and osteoarthritis who presented with 10 days of slurred speech and facial droop, prompting a stroke alert. Initial CT/CTA of the head and neck showed a moderate left frontoparietal hypodensity. Subsequent brain MRI with and without contrast revealed three enhancing lesions plus additional non-enhancing lesions, raising concern for demyelinating disease. Cervical and thoracic spine MRI showed no spinal lesions.<br /><br />Neurology recommended lumbar puncture. The differential diagnosis included acute disseminated encephalomyelitis, MOG antibody disease, paraneoplastic disease, MS, neuromyelitis optica, and neurosarcoidosis. CSF testing for infectious causes was negative, but oligoclonal bands and an elevated IgG index supported an inflammatory demyelinating process. After review with neuroimmunology, the team decided against brain biopsy because the overall clinical and CSF findings were consistent with demyelination. She was discharged with close outpatient neurology and neuroimmunology follow-up.<br /><br />The discussion highlights that tumefactive demyelinating lesions are usually greater than 2 cm and often show mass effect, edema, ring enhancement, and low relative cerebral blood volume on MRI. They commonly occur in the cerebral hemispheres but may involve other CNS regions. Symptoms can range from headache and cognitive changes to hemiparesis, visual symptoms, and seizures. Neuroimaging and serial follow-up can sometimes avoid biopsy, which carries morbidity and mortality risk. Response to steroids and lesion shrinkage over time can help distinguish tumefactive MS from abscess or neoplasm.

Asset Subtitle

Hamid Hussaini

Meta Tag

Author List Hamid Hussaini, Joseph Malzbeder, Kristen (KC) Moore

Category Clinical Vignettes

Concept Tumefactive Multiple Sclerosis

Concept Tumefactive Demyelinating Lesion

Concept Magnetic Resonance Imaging

Concept Brain Lesion

Concept Enhancement Pattern

Distinguished Non-Finalist

Presenter Organization Saint Joseph Internal Medicine Residency

Presenting Author Hamid Hussaini

Track Adult

Keywords

tumefactive multiple sclerosis

demyelinating disorder

brain tumor mimic

magnetic resonance imaging

enhancing lesions

oligoclonal bands

elevated IgG index

lumbar puncture

neuroimmunology

ring enhancement

Tumefactive Multiple Sclerosis

Tumefactive Demyelinating Lesion

Magnetic Resonance Imaging

Brain Lesion

Enhancement Pattern