1/24. Tumor-like presentation of multiple sclerosis.multiple sclerosis patients may present with clinical data suggestive of cerebral tumor, however, most of the lesions do not show expansive signs in computerized tomography of brain or magnetic resonance imaging. We report in this paper, 2 patients who had shown expansive radiological signs suggestive of neoplasm. Cerebral biopsy was an important diagnostic procedure in these 2 cases which revealed the diagnosis of demyelinating disease.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
2/24. Tumor-like multiple sclerosis (MS) lesions: neuropathological clues.The neuroradiological evidence of a single, large white matter lesion with mass effect, clinically revealed by signs of endocranial hypertension, is highly suspicious for central nervous system neoplasm. In rare cases, a demyelinating disorder can start with atypical features suggestive of a brain tumor; in these cases a brain biopsy is often carried out. We report our experience regarding cases of multiple sclerosis (MS) with atypical tumor-like presentation. None of our patients underwent biopsy. Serial magnetic resonance imaging performed during steroid treatment, together with other paraclinical data, were sufficient for the final diagnosis of MS. These cases are characterized by a severe clinical course and a rapid clinical deterioration, only partially modified by medical treatments. Atypical severe cases, misdiagnosed as MS, can be indeed due to primary CNS vasculitis.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
3/24. Conventional MRI and magnetisation transfer imaging of tumour-like multiple sclerosis in a child.Tumefactive multiple sclerosis is a rare entity in children. Differential diagnosis includes other mass lesions such as neoplasm and abscess. A case of tumefactive multiple sclerosis in a child is presented. The open-ring pattern of enhancement on conventional MRI and magnetisation transfer imaging was important for the initial diagnosis and the evaluation of the course of the disease.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
4/24. Tumefactive demyelinating lesions by combined perfusion-weighted and diffusion weighted imaging.Tumefactive demyelinating lesion may sometimes mimic intracranial neoplasm or abscess and pose a diagnostic problem both clinically and radiologically. The diagnosis is even more complicated since multiple sclerosis is relatively uncommon among Chinese and due to low incidence of oligoclonal protein in the cerebrospinal fluid. We present a Chinese lady with tumefactive demyelinating lesion, which mimic cystic neoplasm and cerebral abscess. The use of perfusion and diffusion weighted imaging obviated unnecessary surgical biopsy.- - - - - - - - - - ranking = 2keywords = neoplasm (Clic here for more details about this article) |
5/24. Myelopathy simulating spinal cord tumor.Three cases of demyelinating or necrotizing myelopathy are presented in which gradual onset of symptoms, slowly progressive course and widened cord shadow on myelography led to the erroneous diagnosis of intramedullary spinal cord neoplasm. Two of the cases also had inconclusive surgical explorations. We would suggest that patients who seem to have even a typical clinical and myelographic picutre of an intrinsic cord neoplasm have a period of further observation before radiotherapy is begun and that a vigorous search be made for evidence of disseminated disease.- - - - - - - - - - ranking = 2keywords = neoplasm (Clic here for more details about this article) |
6/24. Monofocal acute inflammatory Demyelination (MAID): a unique disorder simulating brain neoplasm.BACKGROUND: Monofocal acute inflammatory demyelinating (MAID) lesions present as large masses that mimic brain tumors. The natural history and nosologic classification are not well defined. methods: Five patients with MAID from our files and 4 from the literature are presented. We defined MAID as a mass-like lesion, >4 cm in diameter. Demyelination was pathologically proven in all patients. RESULTS: Headaches and motor deficits were the most common presenting symptoms. language problems and motor deficits were the most common findings on physical examination. After a median follow-up of 44 months, none of our 5 patients had multiple sclerosis. In similar cases, additional lesions indicative of multiple sclerosis developed within an average of 8 months. CONCLUSIONS: It may be difficult to distinguish MAID from brain tumor. It may be that MAID represents a unique form of isolated demyelinating disease, or it may represent transition to multiple sclerosis.- - - - - - - - - - ranking = 4keywords = neoplasm (Clic here for more details about this article) |
7/24. Spectroscopic magnetic resonance imaging of a tumefactive demyelinating lesion.Tumefactive demyelinating lesions can present with features similar, clinically and radiologically, to those of brain tumours. Proton MR spectroscopy has been increasingly used to characterize intracranial pathology. As the underlying pathophysiology of neoplasms is different from that of demyelinating disease, one may expect the metabolic composition of neoplasms to be significantly different from that of demyelinating lesions. We report a 49-year-old woman in whom the neurologic and radiologic findings were highly suggestive of a high-grade brain tumor, and the spectroscopic features were sufficiently similar to that of a tumor to convince the neurosurgeon to operate. This case emphasizes the need for caution when confronted with a patient who presents with a differential diagnosis of demyelinating lesion versus neoplasm.- - - - - - - - - - ranking = 3keywords = neoplasm (Clic here for more details about this article) |
8/24. Case report: the vanishing ring sign--an unusual CT manifestation of multiple sclerosis.Ring-like computed tomographic (CT) enhancement of a solitary cerebral mass usually indicates neoplasm or abscess. A 64-year-old man with this sign was found to have multiple sclerosis (MS), and following oral steroid treatment, it disappeared.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
9/24. oligodendroglioma and multiple sclerosis. A case report.BACKGROUND: The concurrence of multiple sclerosis (MS) and glioma is uncommon. Approximately 30 cases have been reported, but in only six of them the tumour was pure or mixed oligodendroglioma. The appearance of new neurological symptoms and signs in a patient with multiple sclerosis is usually attributed to a relapse of this disease and neuroradiological studies are not always performed. When done, the finding of a new focal mass lesion is usually interpreted as a pseudotumoural plaque. CASE REPORT: A 37-year-old man was admitted because of partial simple seizures and an enlarging intracranial mass. He had been diagnosed of MS eleven years earlier. A MRI study performed eight years before admission showed a large mass in the right frontal lobe which was thought to be a pseudotumoural plaque. Two years later, he developed simple partial motor seizures that were initially controlled with valproic acid. He remained well until three months before admission, when seizures reappeared with a poor response to valproic acid. A new MRI study showed an heterogeneous right frontal enlarging mass lesion. A primary neoplasm was suspected and a subtotal removal was performed. The pathological diagnosis was oligodendroglioma with a periferic demyelinating area. CONCLUSION: Atypical MRI lesions in a patient with MS must be carefully interpreted. Pseudotumoural plaques have been described both clinically and radiologically to be hardly distinguishable from a tumoural lesion and histological confirmation is often required. The association between MS and glioma is uncommon but it must be kept in mind when a mass lesion develops in a patient with MS.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
10/24. Enlargement of the spinal cord: inflammation or neoplasm?Intramedullary spinal tumours are uncommon lesions that can cause significant difficulties in the differential diagnosis between inflammatory diseases such as multiple sclerosis and acute disseminated encephalomyelitis, and vascular malformations or neoplasms. We report five cases in which the history and the clinical symptoms suggested an inflammatory process of the spinal cord but the MRI characteristics were those of neoplastic lesions. Both non-neoplastic and neoplastic intramedullary lesion may have very similar symptoms, and even CSF abnormalities, but in every one of our cases, a more detailed history and longer observation of the clinical course would have led to the correct diagnosis; in such problem cases, empirical treatment and a follow-up MRI after a month's observation would be a more prudent approach providing that the patient is not rapidly deteriorating.- - - - - - - - - - ranking = 5keywords = neoplasm (Clic here for more details about this article) |
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