Contributions
Abstract: P817
Type: Poster
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Pseudotumoral or tumefactive demyelinating lesions (TDL) are defined as large inflammatory lesions that associate oedema and/or mass effect, being sometimes misdiagnosed as tumours or other space-occupying lesions. Among all TDL, multiple sclerosis (MS) is the most frequent etiology, but the differential diagnosis encompasses a wide spectrum of diseases.
Objective: To review the clinical and radiological features of patients with TDL treated in our MS-Unit.
Material and methods: We performed a retrospective review of 12 cases of patients with TDL treated in our Unit from January 2010 to March 2016.
Results: The mean age of tumefactive lesion onset was 38 years (± 12.36 SD) with a prevalence of 9 women and 3 men. Out of the 12 patients, 8 had TDL as a first demyelinating event, whereas 3 were previously diagnosed with Relapsing-Remitting MS and 1 with Clinically Isolated Syndrome. Among those presenting with a first event, 50% (n=4) developed definite MS upon follow-up by McDonald Criteria, with a mean time of conversion of 4.4 months (± 1.94 SD). Interestingly, 3 patients had recurrent TDL. All 3 patients with a previous MS diagnosis had been treated with fingolimod (two after cessation and one during treatment)
Clinical presentation in most patients was polysymptomatic, including sensory (42%), visual (25%) and motor (25%) symptoms, as well as seizures (25%) and cognitive changes (17%). The most common radiological findings included solitary lesions (75%), located primarily in the parietal (42%), or in the frontal (25%) and temporal (25%) lobes. An open-ring enhancement pattern was found in 55% of the cases, followed by heterogeneous enhancement (44%). Most (n=7) of the 8 patients with diffusion-weighted magnetic resonance imaging available showed partial restriction. Oligoclonal bands in cerebrospinal fluid were positive in all patients with MS and were not found in those with other diagnoses. MS was the most common diagnosis in our study (n=7, 60%), which represents around 1.2% of MS patients in our Unit. The therapeutic management was mixed, including steroids, plasmapheresis and rituximab.
Conclusions: Prevalence of tumefactive MS in our series was higher than expected in MS patients, according to the literature. Time of conversion to MS was significantly shorter than other published series. Clinical presentation was polysymptomatic and the most common radiological findings were isolated parietal lesions, with an open-ring enhancement.
Disclosure: Pedro Sánchez: nothing to disclose
Virginia Meca-Lallana: nothing to disclose
Antonio Barbosa: nothing to disclose
Itziar Palmí: nothing to disclose
Rafael Manzanares: nothing to disclose
José Vivancos Mora: nothing to disclose
Abstract: P817
Type: Poster
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Pseudotumoral or tumefactive demyelinating lesions (TDL) are defined as large inflammatory lesions that associate oedema and/or mass effect, being sometimes misdiagnosed as tumours or other space-occupying lesions. Among all TDL, multiple sclerosis (MS) is the most frequent etiology, but the differential diagnosis encompasses a wide spectrum of diseases.
Objective: To review the clinical and radiological features of patients with TDL treated in our MS-Unit.
Material and methods: We performed a retrospective review of 12 cases of patients with TDL treated in our Unit from January 2010 to March 2016.
Results: The mean age of tumefactive lesion onset was 38 years (± 12.36 SD) with a prevalence of 9 women and 3 men. Out of the 12 patients, 8 had TDL as a first demyelinating event, whereas 3 were previously diagnosed with Relapsing-Remitting MS and 1 with Clinically Isolated Syndrome. Among those presenting with a first event, 50% (n=4) developed definite MS upon follow-up by McDonald Criteria, with a mean time of conversion of 4.4 months (± 1.94 SD). Interestingly, 3 patients had recurrent TDL. All 3 patients with a previous MS diagnosis had been treated with fingolimod (two after cessation and one during treatment)
Clinical presentation in most patients was polysymptomatic, including sensory (42%), visual (25%) and motor (25%) symptoms, as well as seizures (25%) and cognitive changes (17%). The most common radiological findings included solitary lesions (75%), located primarily in the parietal (42%), or in the frontal (25%) and temporal (25%) lobes. An open-ring enhancement pattern was found in 55% of the cases, followed by heterogeneous enhancement (44%). Most (n=7) of the 8 patients with diffusion-weighted magnetic resonance imaging available showed partial restriction. Oligoclonal bands in cerebrospinal fluid were positive in all patients with MS and were not found in those with other diagnoses. MS was the most common diagnosis in our study (n=7, 60%), which represents around 1.2% of MS patients in our Unit. The therapeutic management was mixed, including steroids, plasmapheresis and rituximab.
Conclusions: Prevalence of tumefactive MS in our series was higher than expected in MS patients, according to the literature. Time of conversion to MS was significantly shorter than other published series. Clinical presentation was polysymptomatic and the most common radiological findings were isolated parietal lesions, with an open-ring enhancement.
Disclosure: Pedro Sánchez: nothing to disclose
Virginia Meca-Lallana: nothing to disclose
Antonio Barbosa: nothing to disclose
Itziar Palmí: nothing to disclose
Rafael Manzanares: nothing to disclose
José Vivancos Mora: nothing to disclose