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Liene Elsone, Ardis Platkajis, Guntis Karelis, Sarmite Dzelzite and Maira Murzina

Tumefactive Multiple Sclerosis Mimicking Neoplasm

Acute demyelination may present as a rapidly expanding space-occupying or tumefactive lesion (TDL). Tumefactive demyelinating lesions are misdiagnosed quite frequently and can result in unnecessary and potentially harmful surgical resection, radiation or toxic chemotherapeutic interventions therapy. Systematic literature review from available articles and abstracts in PubMed database was summarized in purpose to describe typical presentation and diagnostically challenging features of TDL. One clinical case report presenting tumor-like lesion of the brain, when the diagnosis of TDL was established, is added as an illustrative material.

Open access

Liene Elsone, Ardis Platkajis, Guntis Karelis and Ivars Saukans

Frequency and Localization of Spinal Cord Demyelination in MS Patients, Coexistence of Intervertebral Disc Protrusion

Introduction. The importance of spinal cord lesions lies in their presumed greater potential to result in clinical symptoms and disability than white matter lesions in brain, involving as they do clinically eloquent pathways. In clinical practice there are many cases with delayed time of diagnosis in multiple sclerosis patients due to the similarity of the symptoms of disc protrusion to those of MS.

Aim of the Study. To analyze areas of high T2 signal characteristic of demyelination in spinal cord in relationship to clinical manifestation of spinal disturbances and coexistence of intervertebral disc protrusion.

Materials and methods. Retrospective analysis of 150 MS patients was made. Only patients with whole spinal cord scanned and existence of spinal cord lesions in MRI were included. MRI system of GE SIGNA was operated with magnets at field strength 1.0 Tesla, using standardized protocols for spinal cord investigation. Clinical characteristics were analyzed and compared with radiological findings.

Results. Our results showed that spinal cord lesions before clinical manifestation were found in 6.3% of cases. High T2 signal was seen in 88.7% of cervical(C), 58.7% of thoracic (T), and 50% of combination of both(C, T) cords scanned. Higest amount of lesions detected: C3-12,4%, C2-10,2%, C4-9,8%, C5-9,4% levels. Coexistance of intervertebral disc protrusions in MS patients was observed in 36.5% cases

Conclusions. More frequently lesions were located in cervical rather than thoracic cord, the same as intervertebral disc protrusions. Most of the patients having spinal cord lesions have had at least one clinical episode showing spinal cord dysfunction. Intervertebral disc protrusion were found in about third part of MS patients but with no any statistically visible impact on demyelinating process in the spinal cord.