Management of recurrent tumefactive multiple sclerosis: Case report and literature review

Rissardo, Jamir Pitton; Caprara, Ana Letícia Fornari

doi:10.4103/ajns.ajns_94_18

Cited by 7 publications

(4 citation statements)

References 11 publications

(78 reference statements)

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“…A study reported recurrence in five cases of TMS complicated by brain herniation that required an emergency decompressive craniotomy. In all the reports, the initial management included corticosteroids, and one osmotic diuretic, azathioprine (AZA), was added to the treatment in one study [ 12 ]. In most cases, a conservative approach with the use of radiological modalities and clinical follow-up is enough, while other studies used invasive surgical interventions such as brain biopsy or mass resection [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Challenges and Radiological Spectrum of Tumefactive Multiple Sclerosis: A Case Report Study

Muddassir¹,

Badirah²,

Alshahrani³

et al. 2022

Cureus

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Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS). It has many types, which include tumefactive multiple sclerosis (TMS), one of the most uncommon types. We present the case of a 36year-old woman who presented with right-sided numbness of the body. Magnetic resonance imaging (MRI) of the brain revealed a large mass (3 cm × 2.5 cm) in the deep white matter of the right frontal lobe along with smaller lesions of variable sizes. After considering the MRI features, the CSF results, and the improvement of the symptoms with a high dose of steroids, the diagnosis of tumefactive multiple sclerosis was made. A biopsy was not done on our patient as the symptoms resolved after treatment, although sometimes it is necessary for diagnosing tumefactive multiple sclerosis to rule out tumors or abscesses. The current study described the clinical presentation, the role of imaging, the differential diagnosis, and the treatment options. This case report aimed to report a rare presentation of TMS, which highlights the importance of differentiating TMS from other space-occupying lesions for prompt and proper management.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Challenges and Radiological Spectrum of Tumefactive Multiple Sclerosis: A Case Report Study

Muddassir¹,

Badirah²,

Alshahrani³

et al. 2022

Cureus

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“…Recurrent TDL represents a clinical/radiological syndrome that has not been thoroughly described before due to the limited numbers of cases. 18,22,[27][28][29][30] It is unclear whether such cases belong to a separate subset of demyelinating diseases of the CNS or represent a variant of MS. Further clinical evidence on natural history and optimal treatment is warranted. Herein, we present for the first time in the literature 12 patients with recurrent TDL and try to identify any distinct features of this disease entity.…”

Section: Discussionmentioning

confidence: 99%

Clinico-radiologic features and therapeutic strategies in tumefactive demyelination: a retrospective analysis of 50 consecutive cases

Vakrakou

Tzanetakos

Evangelopoulos

et al. 2021

Ther Adv Neurol Disord

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Aims: Our goal was to expand the spectrum of clinico-radiologic characteristics and the possible therapeutic choices in patients with tumefactive demyelinating lesions (TDLs). Methods: A retrospective analysis of 50 patients with at least one TDL was performed at an academic neurology center (2008–2020). Results: Our cohort comprised mostly women (33/50) with a mean age of 38 years at TDL onset. The mean follow-up time was 76 months. The mean Expanded Disability Status Scale score at TDL onset and at the latest neurological evaluation was 3.7 and 2.3, respectively. We subcategorized the patients into seven groups based mainly on the clinical/radiological findings and disease course. Group A included patients presenting with a Marburg-like TDL ( n = 4). Groups B and C comprised patients presenting with monophasic ( n = 7) and recurrent TDLs ( n = 12), respectively. Multiple sclerosis (MS) patients who subsequently developed TDL ( n = 16) during the disease course were categorized as Group D. Group E comprised patients who initially presented with TDL and subsequently developed a classical relapsing–remitting MS without further evidence of TDL ( n = 5). Groups F ( n = 2) and G ( n = 4) involved MS patients who developed TDL during drug initiation (natalizumab, fingolimod) and cessation (interferon, fingolimod), respectively. Regarding long-term treatments applied after corticosteroid administration in the acute phase, B-cell-directed therapies were shown to be highly effective especially in cases with recurrent TDLs. Cyclophosphamide was spared for more aggressive disease indicated by a poor response to corticosteroids and plasma exchange failure. Conclusion: Tumefactive central nervous system demyelination is an heterogenous disease; its stratification into distinct groups according to different phenotypes can establish more efficient treatment strategies, thus improving clinical outcomes in the future.

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“…Fatigue is a common symptom in MS and can exacerbate movement difficulties, leading to increased instability and reduced coordination [118]. The specific movement disorders and their severity can vary among individuals with MS, depending on the location and extent of demyelination and damage to the central nervous system [119].…”

Section: Multiple Sclerosismentioning

confidence: 99%

A Literature Review of Movement Disorder Associated with Medications and Systemic Diseases

Pitton Rissardo,

Fornari Caprara

2024

Preprint

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Movement disorders can be associated with various drugs and systemic diseases, posing diagnostic challenges for clinicians. This review explores the spectrum of movement disorders associated with pharmacological agents and medical conditions. Drug-induced movement disorders encompass a broad range of conditions resulting from exposure to medications that affect several neurotransmitters. Neuroleptic medications can lead to tardive dyskinesia, characterized by involuntary, repetitive movements. Antipsychotics and antiemetics, including metoclopramide, may induce acute dystonic reactions. Other drugs, such as dopamine receptor-blocking agents, can contribute to drug-induced parkinsonism. Beyond medications, movement disorders can also arise secondary to systemic diseases. Metabolic disorders like Wilson's disease, characterized by copper accumulation, may manifest as chorea or dystonia. Inflammatory conditions such as rheumatoid arthritis and systemic lupus erythematosus can result in secondary movement disorders due to autoimmune-mediated processes affecting the central nervous system. Movement disorders linked to drugs or systemic diseases often necessitate a thorough clinical evaluation, including detailed medication histories and comprehensive systemic assessments. Neuroimaging, laboratory investigations, and, in some cases, cerebrospinal fluid analyses and electrodiagnostic studies help in establishing accurate diagnoses. Management involves addressing the underlying cause, modifying medications, and employing symptomatic treatments.

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Management of recurrent tumefactive multiple sclerosis: Case report and literature review

Cited by 7 publications

References 11 publications

Diagnostic Challenges and Radiological Spectrum of Tumefactive Multiple Sclerosis: A Case Report Study

Diagnostic Challenges and Radiological Spectrum of Tumefactive Multiple Sclerosis: A Case Report Study

Clinico-radiologic features and therapeutic strategies in tumefactive demyelination: a retrospective analysis of 50 consecutive cases

A Literature Review of Movement Disorder Associated with Medications and Systemic Diseases

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