Tumefactive multiple sclerosis

Last revised by Yahya Baba on 19 Feb 2023

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 tumefactive multiple sclerosis plaques, 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 now considered true tumefactive demyelinating lesions. 

Differential diagnosis

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