TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORT
Purpose: To present a clinical case of tumefactive multiple sclerosis (TMS), which is an inflammatory demyelinating disease of the central nervous system considered to be a rare form of multiple sclerosis (MS). It belongs to the group of borderline forms of MS – a collective term used to define a sp...
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| Format: | Article |
| Language: | English |
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Peytchinski Publishing
2023-06-01
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| Series: | Journal of IMAB |
| Subjects: | |
| Online Access: | https://www.journal-imab-bg.org/issues-2023/issue2/2023vol29-issue2-4943-4946.pdf |
| _version_ | 1827931383467606016 |
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| author | Magdalina Yanakieva Maya Danovska Emilia Ovcharova Diana Marinova Nicholas Shepherd |
| author_facet | Magdalina Yanakieva Maya Danovska Emilia Ovcharova Diana Marinova Nicholas Shepherd |
| author_sort | Magdalina Yanakieva |
| collection | DOAJ |
| description | Purpose: To present a clinical case of tumefactive multiple sclerosis (TMS), which is an inflammatory demyelinating disease of the central nervous system considered to be a rare form of multiple sclerosis (MS). It belongs to the group of borderline forms of MS – a collective term used to define a spectrum of demyelination-associated neurological conditions that share similar clinical, neuroimaging and histopathological features but vary widely in severity, clinical course and outcome.
Materials/Methods: We describe the case of a 31-year-old female who was admitted to the Neurology clinic of UMHAT “Dr Georgi Stranski” in Pleven, Bulgaria, with a rapid onset of neurological deficit including right-sided hemiparesis, dysarthria, imbalance, cognitive impairment and urinary incontinence. MRI of the brain showed several tumor-like concentric lesions of demyelination surrounded by moderate brain edema, consistent with the radiological criteria for the demyelinating disease.
Results: High-dosage corticosteroids were applied intravenously for this patient as acute therapy. A progressive improvement in the patient was achieved after the extended pulse corticosteroid therapy in combination with physiotherapy. Glatiramer acetate as a disease-modifying treatment was initiated within three months and had substantial efficacy.
Conclusions: The diagnosis of TMS is always difficult and requires not only complex clinical and neuroimaging investigations but also an extensive follow-up of the patient. It is believed that TMS usually has a progressive course and an unfavorable outcome, but a relapsing-remitting course of TMS, albeit rare, is also possible. Our case report confirms that such benign variants of TMS exist. We believe that highlighting such complex clinical cases will contribute to a better understanding of the mystery of MS. |
| first_indexed | 2024-03-13T06:51:43Z |
| format | Article |
| id | doaj.art-8b5a6b4eeedd49c5b262a53ed0fce7a8 |
| institution | Directory Open Access Journal |
| issn | 1312-773X |
| language | English |
| last_indexed | 2024-03-13T06:51:43Z |
| publishDate | 2023-06-01 |
| publisher | Peytchinski Publishing |
| record_format | Article |
| series | Journal of IMAB |
| spelling | doaj.art-8b5a6b4eeedd49c5b262a53ed0fce7a82023-06-07T14:38:20ZengPeytchinski PublishingJournal of IMAB1312-773X2023-06-012924943494610.5272/jimab.2023292.4943TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORTMagdalina Yanakieva0https://orcid.org/0000-0002-6035-5247Maya Danovska1https://orcid.org/0000-0002-5945-2939Emilia Ovcharova2https://orcid.org/0000-0002-2522-4954Diana Marinova3https://orcid.org/0000-0003-4158-8341Nicholas Shepherd4https://orcid.org/0000-0001-5665-3594Department of Neurology, Faculty of Medicine, Medical University – Pleven, Bulgaria.Department of Neurology, Faculty of Medicine, Medical University – Pleven, Bulgaria.Department of Neurology, Faculty of Medicine, Medical University – Pleven, Bulgaria.Department of Neurology, Faculty of Medicine, Medical University – Pleven, Bulgaria.Department of Acute Medicine, Northampton General Hospital, UK.Purpose: To present a clinical case of tumefactive multiple sclerosis (TMS), which is an inflammatory demyelinating disease of the central nervous system considered to be a rare form of multiple sclerosis (MS). It belongs to the group of borderline forms of MS – a collective term used to define a spectrum of demyelination-associated neurological conditions that share similar clinical, neuroimaging and histopathological features but vary widely in severity, clinical course and outcome. Materials/Methods: We describe the case of a 31-year-old female who was admitted to the Neurology clinic of UMHAT “Dr Georgi Stranski” in Pleven, Bulgaria, with a rapid onset of neurological deficit including right-sided hemiparesis, dysarthria, imbalance, cognitive impairment and urinary incontinence. MRI of the brain showed several tumor-like concentric lesions of demyelination surrounded by moderate brain edema, consistent with the radiological criteria for the demyelinating disease. Results: High-dosage corticosteroids were applied intravenously for this patient as acute therapy. A progressive improvement in the patient was achieved after the extended pulse corticosteroid therapy in combination with physiotherapy. Glatiramer acetate as a disease-modifying treatment was initiated within three months and had substantial efficacy. Conclusions: The diagnosis of TMS is always difficult and requires not only complex clinical and neuroimaging investigations but also an extensive follow-up of the patient. It is believed that TMS usually has a progressive course and an unfavorable outcome, but a relapsing-remitting course of TMS, albeit rare, is also possible. Our case report confirms that such benign variants of TMS exist. We believe that highlighting such complex clinical cases will contribute to a better understanding of the mystery of MS.https://www.journal-imab-bg.org/issues-2023/issue2/2023vol29-issue2-4943-4946.pdfdemyelinating diseasemultiple sclerosistumefactive msmagnetic resonance imaging |
| spellingShingle | Magdalina Yanakieva Maya Danovska Emilia Ovcharova Diana Marinova Nicholas Shepherd TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORT Journal of IMAB demyelinating disease multiple sclerosis tumefactive ms magnetic resonance imaging |
| title | TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORT |
| title_full | TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORT |
| title_fullStr | TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORT |
| title_full_unstemmed | TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORT |
| title_short | TUMEFACTIVE MULTIPLE SCLEROSIS: A DIAGNOSTIC ENIGMA. A CASE REPORT |
| title_sort | tumefactive multiple sclerosis a diagnostic enigma a case report |
| topic | demyelinating disease multiple sclerosis tumefactive ms magnetic resonance imaging |
| url | https://www.journal-imab-bg.org/issues-2023/issue2/2023vol29-issue2-4943-4946.pdf |
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