Monday, 31 October 2011

MS presenting as a brain tumour

Kaeser et al. Tumefactive multiple sclerosis: an uncommon diagnostic challenge. J Chiropr Med. 2011 Mar;10(1):29-35. 

OBJECTIVE: A case report describes a rare presentation of MS that was initially diagnosed as a peripheral nerve lesion.

CLINICAL FEATURES: A 30-year-old woman presented with a complaint of a sudden right foot drop. MRI of the brain revealed a large mass in the left parietal lobe with additional white matter lesions. The mass and smaller lesions were consistent with a rare presentation of demyelinating disease, tumefactive* MS. 

* Tumefactive = presenting as a tumour


INTERVENTION AND OUTCOME: The patient was referred to a neurologist for further evaluation and treatment. Her short-term clinical course was punctuated by recurrent myospasms and neurologic deficits.

CONCLUSION: Tumefactive MS may mimic the clinical and MRI characteristics of glioma (brain tumour) or a cerebral abscess. 

"This case illustrates one of the atypical ways in which MS can present and why it is important for clinicians to always consider MS in the differential diagnosis. Other atypical presentations include first seizures, dementia, chronic fatigue and movement disorders."

3 comments:

  1. Somebody who gets "first seizures, dementia, movement disorders" will always go to a doctor. Chronic fatigue isn't that clear. If the sibling (or child or parent) of a person with MS is depressed & tired, should you see a doctor and say you're worried it may be MS again?

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  2. Re: "If the sibling (or child or parent) of a person with MS is depressed & tired, should you see a doctor and say you're worried it may be MS again?"

    A difficult call; it will depend on the severity of the symptoms and the impact on their social and occupational well-being. If they are unable to function properly, almost certainly. On the other side of the coin you don't want to create unnecessary anxiety, hence the emphasis on severity.

    Have I answered your question?

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