Contributions
Abstract: EP1307
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Tumefactive multiple sclerosis (MS) is an atypical form of MS with lesions bigger than 2 centimeters (cm), associated mass effect, perilesional oedema or atypical enhancement pattern that may mimic a brain tumour, abscess or other inflammatory disorders.
Objectives: Our goal is to describe the clinical and imaging patterns of 14 patients with tumefactive MS in order to characterize better this uncommon entity.
Methods: This is a retrospective review of clinical and radiographic material from 14 patients with tumefactive MS that were diagnosed and followed up in our hospital. We have done a descriptive analysis of the demographic features, clinical presentations and outcomes, disability progression measured by Expanded Disability Status Scale (EDSS), brain magnetic resonance imaging (MRI), histopathology of the brain biopsies, cerebrospinal fluid (CSF) and evoked potential results.
Results: There were 9 women and 5 men. The median age at onset was 28 years (2-45). Median disease duration was 8 years (1-17). The most common clinical presentation was motor symptoms (4/14) followed by cognitive and cerebellar dysfunction (2/14). The clinical course at onset was a first neurological event in 9/14, relapsing-remitting in 4/14. One patient only developed tumefactive lesions during his follow-up. Only 3/14 had a monophasic course. Median EDSS was similar at onset and last visit (2.5). 10/14 had demyelinating abnormalities in sensitive and motor evoked potentials. 6/14 had positive oligoclonal bands, 5/14 intratechal synthesis of IgG. In only 3 patients a biopsy was performed and 2/3 biopsies were initially misdiagnosed as a non demyelinating disorder. 1 patient was misdiagnosed as astrocytoma which was surgically removed and treated with radiotherapy. Most lesions had well-defined margins (10/14), with a size 2.1-5cm (8/14), moderate oedema (6/14), T2 hypointense ring (8/14) and ring enhacement (8/14). Lesion volume in subsequent MRIs was reduced in 9/14.
Conclusion: Most had multifocal disease at onset, positive oligoclonal bands and/or abnormal evoked potentials. This along with the reduction of volume lesion during follow-up made it possible to obviate biopsy in many cases.
A better knowledge of the imaging and clinical features of central nervous system inflammatory diseases may facilitate diagnosis, reduce unnecessary biopsies and ensure proper management of theses conditions.
Disclosure: M.V.Castro Sánchez: nothing to disclose
N.L.Ciano Petersen: nothing to disclose
V. Reyes Garrido: nothing to disclose
M. Villagrán García: nothing to disclose
T. Muñoz Ruiz: nothing to disclose
P. Urbaneja Romero: nothing to disclose
MDIP Moreno Arjona: nothing to disclose
G. Pons Pons: nothing to disclose
M. Guerrero Fernández: nothing to disclose
A. León martín: nothing to disclose
A. Alonso Torres: nothing to disclose
P. Serrano Castro: nothing to disclose
Abstract: EP1307
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Tumefactive multiple sclerosis (MS) is an atypical form of MS with lesions bigger than 2 centimeters (cm), associated mass effect, perilesional oedema or atypical enhancement pattern that may mimic a brain tumour, abscess or other inflammatory disorders.
Objectives: Our goal is to describe the clinical and imaging patterns of 14 patients with tumefactive MS in order to characterize better this uncommon entity.
Methods: This is a retrospective review of clinical and radiographic material from 14 patients with tumefactive MS that were diagnosed and followed up in our hospital. We have done a descriptive analysis of the demographic features, clinical presentations and outcomes, disability progression measured by Expanded Disability Status Scale (EDSS), brain magnetic resonance imaging (MRI), histopathology of the brain biopsies, cerebrospinal fluid (CSF) and evoked potential results.
Results: There were 9 women and 5 men. The median age at onset was 28 years (2-45). Median disease duration was 8 years (1-17). The most common clinical presentation was motor symptoms (4/14) followed by cognitive and cerebellar dysfunction (2/14). The clinical course at onset was a first neurological event in 9/14, relapsing-remitting in 4/14. One patient only developed tumefactive lesions during his follow-up. Only 3/14 had a monophasic course. Median EDSS was similar at onset and last visit (2.5). 10/14 had demyelinating abnormalities in sensitive and motor evoked potentials. 6/14 had positive oligoclonal bands, 5/14 intratechal synthesis of IgG. In only 3 patients a biopsy was performed and 2/3 biopsies were initially misdiagnosed as a non demyelinating disorder. 1 patient was misdiagnosed as astrocytoma which was surgically removed and treated with radiotherapy. Most lesions had well-defined margins (10/14), with a size 2.1-5cm (8/14), moderate oedema (6/14), T2 hypointense ring (8/14) and ring enhacement (8/14). Lesion volume in subsequent MRIs was reduced in 9/14.
Conclusion: Most had multifocal disease at onset, positive oligoclonal bands and/or abnormal evoked potentials. This along with the reduction of volume lesion during follow-up made it possible to obviate biopsy in many cases.
A better knowledge of the imaging and clinical features of central nervous system inflammatory diseases may facilitate diagnosis, reduce unnecessary biopsies and ensure proper management of theses conditions.
Disclosure: M.V.Castro Sánchez: nothing to disclose
N.L.Ciano Petersen: nothing to disclose
V. Reyes Garrido: nothing to disclose
M. Villagrán García: nothing to disclose
T. Muñoz Ruiz: nothing to disclose
P. Urbaneja Romero: nothing to disclose
MDIP Moreno Arjona: nothing to disclose
G. Pons Pons: nothing to disclose
M. Guerrero Fernández: nothing to disclose
A. León martín: nothing to disclose
A. Alonso Torres: nothing to disclose
P. Serrano Castro: nothing to disclose