Tumefactive demyelination: updated perspectives on diagnosis and management

Sánchez, Pedro; Chan, Fiona; Hardy, Todd A.

doi:10.1080/14737175.2021.1971077

Cited by 12 publications

(16 citation statements)

References 130 publications

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“…In early stage, some patients may only present mental and cognitive impairment such as memory loss, unresponsiveness, apathy, which are ignored and inadvertently take MRI to find large intracranial lesions, even accompanied by peripheral edema and mass or/and enhanced lesions ( 17 ). Mass-occupying lesions are easily diagnosed as a tumor, such as PCNSL or high-grade glioma ( 9 , 14 , 18 , 19 ). During the phase of TDLs is progressing, symptoms may gradually increase or worsen, and reduced vision may also present.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging and clinicopathological differences between tumefactive demyelinating lesions and sentinel lesions of primary central nervous system lymphoma

Sun

Han

et al. 2022

Front. Immunol.

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ObjectiveIt is still a challenge to distinguish sentinel lesions of primary central nervous system lymphoma (PCNSL) from atypical tumefactive demyelinating lesions (TDLs) in clinical practice. We aimed to investigate potential differences of clinical features, neuroimaging findings and pathological characteristics between PCNSL and TDLs, improving early accurate diagnosis.MethodsIt was a retrospective study involving 116 patients with TDLs and 150 patients with PCNSLs. All cases were pathologically confirmed. Clinical features, neuroimaging findings and pathological characteristics between two groups were analyzed.ResultsThe onset age was 37 ± 14 years in TDLs and 58 ± 13 years in PCNSL(p=0.000). Main onset symptom was headache in TDLs, while cognitive impairment was frequently noted in PCNSL. CT brain scan image showed hypodense lesions in most cases of TDL (110/116, 94.8%), while approximately 80% patients (120/150) with PCNSL had hyperdense lesions. Furthermore, we found that the presence of Creutzfeldt-Peters cells (might be misdiagnosed as tumor cells) may serve as an important feature in TDLs.ConclusionsOnset age of patients with TDLs was younger than PCNSL. Neuroimaging features on brain CT scan might provide clues to make a differential diagnosis. Pathological features of PCNSL with sentinel lesions or following steroids therapy might mimic TDLs. Dynamic neuroimaging pathological and follow-up information were essential for an accurate diagnosis.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging and clinicopathological differences between tumefactive demyelinating lesions and sentinel lesions of primary central nervous system lymphoma

Sun

Han

et al. 2022

Front. Immunol.

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“…4,5 Similar to MS, tumefactive lesions appear to be more common in female patients overall, but some etiologies of tumefactive demyelination, such as ADEM, may be more common in male patients. 6 Presentation Tumefactive demyelination, when it occurs, is usually the initial presentation of a demyelinating disease, but it can occur in patients with previously diagnosed MS or with other relapsing-remitting or progressive demyelinating diseases. 7 Similar to other demyelinating disorders, tumefactive demyelination causes various motor, sensory, or cerebellar abnormalities depending on the location of the lesions and occurs over a subacute time frame.…”

Section: Tumefactive and Aggressive Demyelinationmentioning

confidence: 99%

Emergent Management of Central Nervous System Demyelinating Disorders

Czeisler

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article reviews the various conditions that can present with acute and severe central nervous system demyelination, the broad differential diagnosis of these conditions, the most appropriate diagnostic workup, and the acute treatment regimens to be administered to help achieve the best possible patient outcomes. LATEST DEVELOPMENTS The discovery of anti–aquaporin 4 (AQP4) antibodies and anti–myelin oligodendrocyte glycoprotein (MOG) antibodies in the past two decades has revolutionized our understanding of acute demyelinating disorders, their evaluation, and their management. ESSENTIAL POINTS Demyelinating disorders comprise a large category of neurologic disorders seen by practicing neurologists. In the majority of cases, patients with these conditions do not require care in an intensive care unit. However, certain disorders may cause severe demyelination that necessitates intensive care unit admission because of numerous simultaneous multifocal lesions, tumefactive lesions, or lesions in certain brain locations that lead to acute severe neurologic dysfunction. Intensive care may be necessary for the management and prevention of complications for patients who have severely altered mental status, rapidly progressive neurologic worsening, elevated intracranial pressure, severe cerebral edema, status epilepticus, or respiratory failure.

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“…associated with MS, which means that this entity is not considered in the differential diagnoses and a neoplasm or infection is suspected. However, even if there is a pre-existing diagnosis of MS, the probability of presenting a neoplasm or nonmyelinating pathology is not ruled out, which leads to suggest a biopsy to diagnose the pathology (11,17,18).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Tumefactive multiple sclerosis

Ortega-Sierra¹,

Delgado-Marrugo²,

Campo-Bedoya³

et al. 2021

roneuro

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Tumefactive multiple sclerosis is a rare variant of multiple sclerosis, characterized by the presence of brain lesions that may be solitary or multiple. Considering that these lesions have a pseudotumoral appearance, it is a challenge to differentiate them from central nervous system neoplasms through neuroimaging. Many cases are associated with the administration of monoclonal antibodies, and due to an increase in the incidence of cancer globally, it is expected that secondary to chemotherapeutic treatments, more and more cases may appear. Taking into account the above, the objective of this review is to review aspects of usefulness in clinical practice, on the diagnosis and approach of this pathological condition

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Tumefactive demyelination: updated perspectives on diagnosis and management

Cited by 12 publications

References 130 publications

Neuroimaging and clinicopathological differences between tumefactive demyelinating lesions and sentinel lesions of primary central nervous system lymphoma

Neuroimaging and clinicopathological differences between tumefactive demyelinating lesions and sentinel lesions of primary central nervous system lymphoma

Emergent Management of Central Nervous System Demyelinating Disorders

Tumefactive multiple sclerosis

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