Neurological Disorders and Stroke

Biography

Biography: Mohammed Hmoud

Abstract

Tumefactive multiple sclerosis (TMS) is an inflammatory demyelinating disease characterized by lesions measuring more than 2 cm. TMS may occur at any age, however, it is more frequent between the second and third decades of life. Some studies state that TMS has a female gender predilection, while others deny any gender predominance. The incidence of the disease is 1 to 2 per 100 cases of MS and 3 cases per million per year in the general population. TMS commonly behaves as a mass occupying lesion. Hence, the clinical presentation varies according to the location and size of the lesion. The most prevalent symptoms at presentation are motor, cognitive (memory deficit, attention disorders and mental confusion) and sensory dysfunction respectively. Pathologically, TMS is characterized by hyper-cellular lesions with demyelination and foamy macrophages which indicate a myelin phagocytosis. Magnetic resonance imaging is considered the modality of choice to diagnose this rare demyelinating disease. However, TMS presents a diagnostic challenge as it mimics several neoplastic and inflammatory conditions. The majority of patients with TMS respond to corticosteroid therapy. Unfortunately, some may have suboptimal results with corticosteroids. Hence, other immunomodulatory modalities would be indicated. Surgical intervention might be beneficial to some patients presenting with high intracranial pressure and severe swelling. In this paper, we describe a case of tumefactive multiple sclerosis in a pregnant lady with its clinical and radiological features, with a demonstration of a new approach to steroid resistant aggressive cases.