Jain Rajendra Singh, Khan Ibraheem, Kandelwal Kapil, Desai Tushar
Department of Neurology, SMS Medical College, Jaipur, 302004, Rajasthan, India.
Department of Neurology, SMS Medical College, Jaipur, 302004, Rajasthan, India.
Clin Neurol Neurosurg. 2017 Nov;162:91-94. doi: 10.1016/j.clineuro.2017.09.013. Epub 2017 Sep 29.
Diagnosis of tumefactive demyelination lesions (TDLs) is challenging to neurophysician, neuroradiologist or neurosurgeon. Our objective in this study was to analyze clinicoradiological features of TDLs.
A retrospective analysis with prospective follow-up of 11 cases of TDLs was performed. Study was conducted in the neurology department of a tertiary care centre of North-West India from August 2014 to March 2017. MRI of brain and cervical spine with contrast, visual evoked potential, oligoclonal bands, serum anti-AQP4 antibody and MRS performed in most of the patients.
Mean age of tumefactive demyelinating lesions was 19.63 years (10-41) with male preponderance (M: F=1.4) and one of the patients was in a pediatric age group. Relapsing and demyelinating courses of disease, seizure and incomplete ring enhancement were found in 6 out of 11(54.5%), 4 out of 11 (36.3%) 3 out of 11(27.2) respectively. OCBs were positive in 4 out of 5 patients (80%).
Recognition of atypical presentation or clinicoradiological features would aid in diagnosis along with visual evoked potential, oligoclonal bands and responsiveness to steroids may obviate the need for invasive procedure like brain biopsy.
对于神经科医生、神经放射科医生或神经外科医生而言，瘤样脱髓鞘病变（TDLs）的诊断颇具挑战性。本研究的目的是分析TDLs的临床放射学特征。
对11例TDLs患者进行了回顾性分析及前瞻性随访。研究于2014年8月至2017年3月在印度西北部一家三级医疗中心的神经内科开展。多数患者进行了头颅和颈椎的增强MRI、视觉诱发电位、寡克隆带、血清抗水通道蛋白4抗体检测及磁共振波谱分析。
瘤样脱髓鞘病变患者的平均年龄为19.63岁（10 - 41岁），男性居多（男∶女 = 1.4），其中1例患者为儿童。11例患者中分别有6例（54.5%）出现疾病复发及脱髓鞘病程、4例（36.3%）出现癫痫、3例（27.2%）出现不完全环形强化。5例患者中有4例（80%）寡克隆带呈阳性。
认识不典型表现或临床放射学特征有助于诊断，同时视觉诱发电位、寡克隆带以及对类固醇的反应可能无需进行脑活检等侵入性检查。
