Case Presentation: We present a 59-year-old female with a past medical history of uterine fibroids and osteoarthritis who initially presented to the emergency department with a stroke alert for 10 days of slurred speech and facial droop. The patient was traveling with her husband in San Diego 2 weeks prior. Upon her return, she noticed slurred speech that she initially attributed to cold sores in her mouth. On admission, she underwent computerized tomography/computerized tomography with an angiogram of the head and neck that showed a moderate left frontoparietal hypodensity. Neurosurgery was consulted and recommended magnetic resonance imaging (MRI) of the brain with and without contrast that later showed 3 enhancing lesions as well as non-enhancing lesions thought to represent demyelination. Thoracic and cervical spine MRI with and without contrast did not show any spinal lesions. A lumbar puncture was performed demonstrating normal WBC but elevated protein with the presence of oligoclonal bands and an elevated IgG index. Cerebrospinal fluid cultures were negative and were also negative for the presence of toxoplasma, Cryptococcus, and fungi. The serologic HIV test was also negative. Based on these findings and per the suggestion of consultants including a neuroimmunologist, An additional biopsy was not pursued, and a clinical diagnosis of demyelination condition was established. The patient was subsequently discharged without treatment and with close follow-up with outpatient Neurology.
Discussion: Tumefactive multiple sclerosis (MS), a unique kind of demyelinating illness, is typified by lesions that resemble other space-occupying lesions such as neoplasms, infections, and infarction on radiographic imaging. Because of the broad differential of such lesions, there is diagnostic difficulty that often requires histological study, particularly when the patient’s medical history is inconsistent with MS.
Conclusions: Tumefactive multiple sclerosis (MS) can resemble the clinical and magnetic resonance imaging features of a brain abscess or glioma. This case report serves as an example of how early diagnosis and effective treatment of MS depend on identifying the disease’s many, occasionally unusual, and often cryptic clinical and imaging presentations
