Tumefactive Multiple Sclerosis: Symptoms, Diagnosis, and Treatments

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  • Multiple Sclerosis Basics

    Multiple Sclerosis Basics

    Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS). MS causes inflammation and damage to myelin, a fatty substance that surrounds nerve cells. Eventually, scar tissue forms (lesions). Lesions are typically small and appear in multiple locations.

    MS interferes with the transmission of signals from the CNS to the rest of the body. This can cause a wide variety of symptoms, depending upon the location of the lesions. Some people with MS have clear relapses and remissions from the disease, while others have a progressive form of the disease.

    Click through the slideshow to get a better understanding of this form of the disease.

  • Tumefactive Multiple Sclerosis

    Tumefactive Multiple Sclerosis

    Tumefactive MS is an extremely rare form of the disease. It involves brain lesions that are two cm or larger and appear to be tumors. These lesions are more aggressive than typical MS lesions.

    Most people who have tumefactive brain lesions have MS, but there can be other causes of the lesions, so it’s important to seek the correct diagnosis.

  • Symptoms

    Symptoms

    There are many potential symptoms of MS, including problems with balance and coordination. MS patients also may experience fatigue, weakness, and vertigo. Bladder dysfunction and mobility problems are not uncommon.

    People with tumefactive lesions may experience some symptoms that are atypical of MS. These include:

    • headache
    • seizures
    • brainstem dysfunction
    • language problems (aphasia)
    • cortical sensory loss
    • psychosis

  • MRI

    MRI

    On MRI scans, multiple small lesions generally indicate a case of MS. A larger solitary mass, with or without ring enhancement, may be a sign of tumefactive MS.

    Patients with tumefactive tumors often go on to develop MS, but doctors can’t be certain. That’s why other tests and regular follow-ups with a neurologist are essential.

  • Diagnosis

    Diagnosis

    It can be difficult to determine if a mass is a tumefactive lesion or another type of brain tumor. Sometimes imaging tests like MRI alone are inconclusive. Additional diagnostic testing may include:

    • complete neurological examination
    • evoked potentials
    • lumbar puncture (spinal tap)
    • blood work

    To rule out other diagnoses, it may be necessary to perform a biopsy of the lesion.

  • Differential Diagnoses

    Differential Diagnoses

    Before treatment can begin, your doctor must diagnose lesions in the brain. What may appear to be a case of tumefactive MS may be something else. Other possibilities include:

    • acute disseminated encephalomyelitis (ADEM)
    • brain abscess
    • brain metastasis (cancer that has spread from another part of the body)
    • CNS lymphoma (a rare type of non-Hodgkin lymphoma)
    • cerebral inflective process/cerebritis (infection of the brain)
    • primary brain tumor

  • Treatment

    Treatment

    Tumefactive lesions usually respond well to high-dose intravenous corticosteroids. Rarely do new tumefactive lesions form from this kind of treatment.

    Disease modifying medications can reduce disease activity and delay disease progression in people with MS. If you’re diagnosed with MS, discuss these options with your doctor.

    Other medications are used to manage specific symptoms. Physical therapy and complementary therapies like meditation, yoga, and massage can be used to manage symptoms. However, currently there is no cure for MS.

  • Prognosis

    Prognosis

    Aggressive initial treatment for tumefactive MS is important. The long-term outcome is generally good. Most people with tumefactive lesions go on to develop relapsing-remitting MS (RRMS).

    As with all forms of MS, long-term outlook is difficult to assess. Most people with MS don’t develop severe disabilities. Quality of life varies from patient to patient. Except in rare cases, people with MS can expect a normal lifespan.

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