Presentation
Right facial droop, right arm and leg weakness.
Patient Data
Age: 45 years
Gender: Male
From the case:
Inflammatory demyelinating pseudotumor
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Large area of low attenuation involves the left frontal lobe with mass effect.
From the case:
Inflammatory demyelinating pseudotumor
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Mass-like T2 signal change in the left frontal lobe, extending into the corpus callosum and right frontal lobe. Poorly defined, incomplete peripheral enhancement. A few associated punctate foci of diffusion restriction and susceptibility.
Case Discussion
Inflammatory Demyelinating Pseudotumor
As the name suggests is a demyelinating process, typically acute and fulminant with mass effect. The condition mimics tumor on imaging and pathology.
The key to diagnosis is the enhancement pattern - peripheral, incomplete, and often poorly defined or 'wispy'.
Pathological features include:
- Well defined borders
- Uniform distribution of foamy macrophages
- No coagulative necrosis
- Sheets of gemistocytic astrocytes with well formed processes
- Perivascular chronic inflammatory cell infiltration
- Absence of myelin with preservation of axons
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