Presentation
Left sided weakness
Patient Data
(MRI from another institution) Centered in the posterior right frontal lobe is a large rounded lesion. Centrally there is an area of very high T2 signal with partial suppression on FLAIR. This is surrounded by incomplete open-ring enhancement which, in turn, is surrounded by vasogenic edema. The enhancing component demonstrates profound diffusion restriction whereas the central component has facilitated diffusion.
Additional areas of non-enhancing T2 signal change are noted elsewhere. No other enhancing lesions are present; phase artefact from the vein of Galen and sigmoid sinus mimic enhancement in the peritrigonal white matter and cerebellum respectively.
Conclusion:
Findings are most in keeping with tumefactive demyelination, likely on the background of multiple sclerosis (additional non-enhancing seemingly old white matter lesions).
Because the intial scan was reported as likely representing a glioma, the mass was biopsied. Histological examination confirmed the diagnosis of tumefactive demyelination.
MRI 13 years later shows typical changes of multiple sclerosis with multiple white matter plaques. The area of the previous biopsy and tumefactive demyelination is a gliotic cavity.
Case Discussion
The patient remains well, although they have ongoing multiple sclerosis.
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