Tumefactive demyelinating lesions: spectrum of disease, diagnosis andtreatment

Demyelination in the central nervous system sometimes presents with large pseudotumoral lesions mimicking brain neoplasm. Whether tumefactive demyelination constitutes a disease variant within the broad spectrum of multiple sclerosis or rather depicts a different entity is still matter of debate. Thus far, no consensus exists about definition and management of tumefactive lesions since the only available evidence comes from small case series and hospital cohort studies. Pseudotumoral plaques may occur as first neurological event or in the course of well-established MS diagnosis making the distinguishing between demyelination and malignancy even more challenging. Extensive diagnostic work-up is mandatory for proper identification of tumefactive demyelinating lesions (TDLs) to avoid unnecessary and potentially harmful interventions. Despite the lack of patognomonic features, several radiological hallmarks of TDLs can be outlined. Unfortunately in most of cases diagnosis is not straightforward and brain biopsy in eventually required. The aim of this paper is to review clinical findings, diagnostic procedures and treatment of this challenging pathological condition.