Open rings of demyelination – a rare case of tumefactive multiple sclerosis

Abstract

Introduction and aim. Tumefactive multiple sclerosis (MS), a rare and atypical subtype of MS, presents with large demyelinating lesions that can mimic acute stroke, leading to diagnostic uncertainty. Stroke-like symptoms in such cases require a thorough neuroimaging. We describe the case of a 35-year-old woman who presented with acute onset of right-sided hemiparesis and hemisensory loss, along with facial weakness of the left upper motor neuron facial weakness and focal seizures. Initially suspected to be a cerebrovascular event, the condition was later diagnosed as tumefactive multiple sclerosis.

Description of the case. Comprehensive neurological assessment with neuroimaging and magnetic resonance peduncle, and bilateral cerebral hemispheres, raising suspicion of a demyelinating process. A differential diagnosis, including neoplastic, infectious, and inflammatory conditions was carefully evaluated before confirming tumefactive MS. The patient’s stroke-like deficits improved significantly with high-dose intravenous methylprednisolone therapy. Follow-up imaging demonstrated the resolution of the enhancing lesions, strengthening the diagnosis. The dramatic response to steroids and the absence of progressive deterioration helped differentiate tumefactive MS from gliomas or infectious abscesses.

Conclusion. This case highlights the importance of considering tumefactive MS in acute neurological deficits with ring-enhancing lesions. Advanced imaging techniques are crucial for accurate differentiation that allows for timely and appropriate treatment.