Tumefactive Demyelinating Lesions(TDLs): A Case series of clinicoradiological features

Publication date: Available online 29 September 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Rajendra Singh Jain, Ibraheem Khan, Kapil Kandelwal, Tushar Desai
ObjectiveDiagnosis of tumefactive demyelination lesions(TDLs) is challenging to neurophysician, neuroradiologist or neurosurgeon. Our objective in this study was to analyze clinicoradiological features of TDLs.Patients and MethodA retrospective analysis with prospective follow-up of 11 cases of TDLs was performed. Study was conducted in the neurology department of a tertiary care centre of North-West India from August 2014 to March 2017. MRI of brain and cervical spine with contrast, visual evoked potential, oligoclonal bands, serum anti-AQP4 antibody and MRS performed in most of the patients.ResultsMean age of tumefactive demyelinating lesions was 19.63 years (10 –41) with male preponderance (M: F=1.4) and one of the patients was in a pediatric age group. Relapsing and demyelinating courses of disease, seizure and incomplete ring enhancement were found in 6 out of 11(54.5%), 4 out of 11 (36.3%) 3 out of 11(27.2) respectively. OCBs were positive in 4 out of 5 patients (80%).ConclusionRecognition of atypical presentation or clinicoradiological features would aid in diagnosis along with visual evoked potential, oligoclonal bands and responsiveness to steroids may obviate the need for invasive procedure like brain biopsy.



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