Multiple sclerosis that appears with a magnetic resonance image similar to a tumor in appearance has been considered a relatively rare condition: 1-2/1000 cases of multiple sclerosis or around 3 cases per million habitants per year. The demyelinating diseases of the central nervous system include a broad spectrum of different etiologies, with multiple sclerosis being the most frequent one. Multiple sclerosis is a chronic demyelinating disease, autoimmune and inflammatory that affects all the central nervous system. The diagnostic criteria require magnetic resonance imaging in which demyelinating areas can be appreciated. Occasionally atypical lesions of multiple sclerosis are identified, showing a size, morphology and pattern of unusual contrast enhancement. Pseudotumoral lesions represent one of these atypical forms of lesions in multiple sclerosis. The treatment of pseudotumoral forms of multiple sclerosis is not well defined. In cases reported in literature corticoid therapy is the one that is used the most. We present the case of a 24 year old female patient, without vascular risk who presented with rapidly progressive right hemiparesis accompanied by mutism. Image studies show multifocal white matter lesions predominantly in the fronto-parietal region, with pseudotumoral demyelinating features, compatible with demyelinating disease, confirmed by biopsy for which corticoid treatment was started with satisfactory outcome. The acute variants of multiple sclerosis must be taken into consideration in all cases of pseudotumoral lesions with symptoms pertinent to multiple sclerosis, in spite of it being a rare variant, it´s course is usually acute and fulminant, and so, a timely detection and management is essential.
Alex Medina, Jeaneth Bú, Claudia Ávila-De la Puente, Rina Medina-Escobar, Pedro Mauricio Gómez, Madelin Olivia Garcia-Espinoza2
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