Lin Michelle, Reid Patrick, Bakhsheshian Joshua
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2018 Apr;112:37-38. doi: 10.1016/j.wneu.2018.01.013. Epub 2018 Jan 10.
Tumefactive multiple sclerosis is a demyelinating lesion that can radiographically mimic high-grade gliomas during acute episodes, thus affecting clinical decision making. A delay in appropriate diagnoses can result in unnecessary invasive resections. The following case is a patient with unilateral weakness and radiologic findings that were concerning for a high-grade glioma. Peripheral studies were equivocal. The decision was made to proceed with a stereotactic biopsy, yielding a definitive diagnosis of tumefactive demyelinating lesion (TDL). The patient responded robustly to medical management and made a full clinical recovery. While TDLs and gliomas may look radiologically identical during acute demyelinating episodes, unlike gliomas, TDLs will demonstrate evolvement over serial imaging and robust clinical response to high dose steroids. Clinicians should proceed with caution when considering invasive procedures with such lesions. Conservative medical management is often sufficient as seen in this patient. This case highlights the importance of timely diagnosis and management of TDLs.
瘤样脱髓鞘病变是一种脱髓鞘性病变，在急性发作期影像学上可类似于高级别胶质瘤，从而影响临床决策。诊断延迟可能导致不必要的侵入性切除。以下病例是一名有单侧无力症状且影像学表现提示为高级别胶质瘤的患者。外周检查结果不明确。决定进行立体定向活检，最终确诊为瘤样脱髓鞘病变（TDL）。该患者对药物治疗反应良好，临床完全康复。虽然TDL和胶质瘤在急性脱髓鞘发作期影像学表现可能相同，但与胶质瘤不同的是，TDL在系列影像学检查中会有变化，且对大剂量类固醇有显著临床反应。临床医生在考虑对这类病变进行侵入性操作时应谨慎。如该患者所示，保守的药物治疗通常就足够了。本病例强调了及时诊断和治疗TDL的重要性。
