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Thirty-one patients with large,focal cerebral demyelinating lesions are reported.Twenty-four patients had solitary lesions and seven had multiple foci,the latter apparently of identical age.The lesions presented clinically and radiologically as brain tumors(gliomas or metastases)or as multiple cysts.Six patients were older than 57 years(2 in their 70's)at the onset of their symptoms.The demyelinating nature of the lesion was established through biopsy in each patient and all improved significantly after corticosteroid therapy.Three patients developed additional lesions during the follow-up periods ranging from 9-12 years consistent with the course of multiple sclerosis.Twenty eight patients did not developed additional lesions.These included 6 patients with multiple lesions at the onset.In 1 of the patients,the first symptoms developed 10 days after receiving vaccinating against influenza.Two patients had concomittant malignancy(chronic monomyelogenous leukemia and retroperitoneal seminoma respectively)and 1 patient developed immunoblastic sarcoma in the opposite hemispheric after biopsy diagnosis and steroid treatment of her demyelinating lesion.Tumor-like masses of demyelination may occupy an intermediate postition between multiple sclerosis and postinfectious/post vaccination encephalitis.The clinical course(history of vaccination in one instance,acute onset,good response to corticosteroids,no clinical or radiological evidence of new lesions in the great majority of patients) favored postinfectious/postvaccinated encephalitis.Lesion size however greatly exceeded that of the small foci of perivenous demyelination seen in typical postinfectious/postvaccination encephalitis and tended to present as space occupying masses. |
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acute disseminated encephalomyelitis
brain biopsy
CAT scan
CAT scan,abnormal
CAT scan,demyelinating disease
cyst,cortical parenchyma
demyelinating disease
encephalitis
encephalomyelitis,postinfectious
gadolinium
glioma
misdiagnosis
MRI
MRI,abnormal
MRI,contrast enhanced
MRI,demyelinating disease
multiple sclerosis
multiple sclerosis,misdiagnosis
multiple sclerosis,tumefactive
neoplasm,metastatic to CNS
neoplasm,primary intracerebral
neoplasm,primary of CNS
pseudotumor
vaccination,neurologic complications with
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