Bilateral Tumefactive Multiple Sclerosis Lesions

Abstract

Tumefactive lesions are a rare form of multiple sclerosis (MS) presentation often provoking a diagnostic dilemma with brain tumour or abscess. We describe two cases of tumefactive demyelinating MS plaques and two different approaches. In the first patient the clinical and laboratory findings were consistent with MS, a diagnosis supported by the rapid response to high-dose steroid treatment. On the contrary, atypical clinical, imaging and laboratory findings in our second patient misled us to a diagnosis of a brain tumour. The diagnosis of MS was made after histopathological examination of the excised mass. Both our patients developed a second tumor-like demyelinating mass in the contralateral and almost homologous white matter two years after their first admission to our hospital. A brief review of the imaging diagnostic approach to tumor-like MS plaques and changes appearing in the contralateral and especially in the homologous white matter of MS patients is reported.