TUMEFACTIVE DEMYELINATING LESION MIMICKING GLIOMA: A CLINO- RADIOPATHOLOGICAL CONUNDRUM: A RARE CASE REPORT AND REVIEW OF LITERATURE

• Shivangi Prakash Gandhi,*  
• Minesh Gandhi,  
• Daksha Damor,  
• Darshan Parmar,  
• Cherry Shah,  
• Nanda Jagrit

Abstract

Tumefactive demyelinating lesions are large demyelinating lesions that present with significant mass effect and surrounding edema. They are most commonly associated with multiple sclerosis (MS). A heterogeneous group of CNS idiopathic inflammatory demyelinating diseases, including MS, clinically isolated syndrome (CIS), rare variants of MS, acute demyelinating encephalomyelitis (ADEM), acute hemorrhagic leukoencephalitis, and neuromyelitis optica (NMO), can cause tumefactive demyelinating lesions. The rare tumefactive variants of MS include Schilder’s disease, Marburg acute MS, and Balo’s concentric sclerosis. The prevalence of tumefactive demyelination has not been formally evaluated but it is estimated to be approximately 1–2 per 1000 cases of Multiple Sclerosis2. Patient usually present at median age of 30- 40 years. Females are slightly more affected than males. Tumefactive demyelinating (TD) lesions are larger than those seen in typical MS (i.e, >2 cm) and may occur in patients either with or without established MS. Tumefactive demyelinating lesions are commonly located in the cerebral hemispheric white matter, especially the frontal and parietal lobes, but can be found elsewhere in the CNS.

Keywords

Tumefactive demyelinating lesions (TDL), Multiple Sclerosis, mass effect, edema