Tumefactive multiple sclerosis is a term used to describe patients with established multiple sclerosis who develop large aggressive demyelinating lesions, similar/identical in appearance to those seen in sporadic tumefactive demyelinating lesions (TDL). TDL is now considered to be a separate entity, lying on a spectrum between multiple sclerosis and postinfectious demyelination / acute disseminated encephalomyelitis (ADEM) 1-3.
This appears at first to be an unnecessarily complicated and pedantic distinction, however, this is potentially important as patients who present with a tumefactive demyelinating lesion do not usually progress to multiple sclerosis 1-2. Additionally, there may be histopathological differences between a TDL and a tumefactive multiple sclerosis plaque, namely the presence of more pronounced axonal damage in the latter 1.
When reading about demyelination, one must be wary of older publications that do not draw a distinction between multiple sclerosis with larger tumefactive-like lesions and what is not considered true tumefactive demyelinating lesions.
- 1. Given CA, Stevens BS, Lee C. The MRI appearance of tumefactive demyelinating lesions. AJR Am J Roentgenol. 2004;182 (1): 195-9. doi:10.2214/ajr.182.1.1820195 - Pubmed citation
- 2. Kepes JJ. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann. Neurol. 1993;33 (1): 18-27. doi:10.1002/ana.410330105 - Pubmed citation
- 3. Uriel A, Stow R, Johnson L et-al. Tumefactive demyelination-an unusual neurological presentation of HIV. Clin. Infect. Dis. 2010;51 (10): 1217-20. doi:10.1086/656812 - Pubmed citation
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