Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Pseudotumoral multiple sclerosis: unveiling its clinical and imaging characteristics.
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Fernandes André Aires, de Carvalho Sara, Vedor Sofia, Carvalho Bruno, Ferro Daniela, Seabra Mafalda, Dos Reis Ricardo Soares, Mendonça Teresa, Reis Carina, Sá Maria José, Guimarães Joana, Abreu Pedro
Аннотация
INTRODUCTION: Pseudotumoral Multiple Sclerosis (PTMS) is characterized by lesions larger than two centimeters and/or with a tumefactive appearance, mimicking brain tumors or other space-occupying lesions.
OBJECTIVES: We ought to describe of a cohort of patients diagnosed with PTMS, encompassing detailed imaging analyses, clinical evaluations, and neuropsychological outcomes.
METHODS: We conducted a retrospective study of patients diagnosed with PTMS according to the 2017 McDonald criteria, followed in a tertiary center between January 2000 and April 2024.
RESULTS: Eighteen patients were included, 15 (83.3%) of whom were female. All patients fulfilled criteria for relapsing-remitting multiple sclerosis (RRMS), with TDL being the initial manifestation in 13 patients. In seven patients, RRMS diagnosis was delayed by a median of 12 months. Sixteen patients exhibited TDL-related neurological symptoms, predominantly motor impairment (n = 15). A total of 27 TDL were detected, presenting as a single lesion in 14 patients (77.8%). Most were supratentorial (n = 20, 74.1%), with infiltrative (n = 11) and ring-like (n = 10) being the most common morphological patterns. Gadolinium enhancement was documented in 13 patients, predominantly exhibiting diffuse/patchy (n = 10) or incomplete ring (n = 7) patterns. Three patients underwent lesion biopsy. The median follow-up period was four years (IQR:1.5-10.4). All patients showed clinical improvement, as corroborated by a reduction in the median EDSS (median = 0.75). Cognitive decline was detected in four patients on last neuropsychological evaluation.
DISCUSSION: PTMS exhibits substantial clinical and imaging heterogeneity, often requiring a high index of suspicion for accurate diagnosis. Patients showed overall improvement in functional outcomes; however, this should be interpreted with caution given the occurrence of significant iatrogenic morbidity related to brain biopsy and cognitive decline in a subset of patients.
OBJECTIVES: We ought to describe of a cohort of patients diagnosed with PTMS, encompassing detailed imaging analyses, clinical evaluations, and neuropsychological outcomes.
METHODS: We conducted a retrospective study of patients diagnosed with PTMS according to the 2017 McDonald criteria, followed in a tertiary center between January 2000 and April 2024.
RESULTS: Eighteen patients were included, 15 (83.3%) of whom were female. All patients fulfilled criteria for relapsing-remitting multiple sclerosis (RRMS), with TDL being the initial manifestation in 13 patients. In seven patients, RRMS diagnosis was delayed by a median of 12 months. Sixteen patients exhibited TDL-related neurological symptoms, predominantly motor impairment (n = 15). A total of 27 TDL were detected, presenting as a single lesion in 14 patients (77.8%). Most were supratentorial (n = 20, 74.1%), with infiltrative (n = 11) and ring-like (n = 10) being the most common morphological patterns. Gadolinium enhancement was documented in 13 patients, predominantly exhibiting diffuse/patchy (n = 10) or incomplete ring (n = 7) patterns. Three patients underwent lesion biopsy. The median follow-up period was four years (IQR:1.5-10.4). All patients showed clinical improvement, as corroborated by a reduction in the median EDSS (median = 0.75). Cognitive decline was detected in four patients on last neuropsychological evaluation.
DISCUSSION: PTMS exhibits substantial clinical and imaging heterogeneity, often requiring a high index of suspicion for accurate diagnosis. Patients showed overall improvement in functional outcomes; however, this should be interpreted with caution given the occurrence of significant iatrogenic morbidity related to brain biopsy and cognitive decline in a subset of patients.