뇌종양으로 오인된 탈수초성 가성종양

초록

PURPOSE : Acute tumour-like demyelination or demyelinating pseudotumour is a variant presentation of demyelinating diseases, such as multiple sclerosis. The presentation of demyelinating Pseudotumor as a solitary mass lesion closely mimics neoplasia radiologically and histopathologically. Because misdiagnosis can result in unwarranted and overly aggressive therapy. it is critical for the neurosurgeon to be aware of this serious diagnostic pitfall MATERIALS AND METHODS : A 32 year old male developing left side grand mal seizure lasting 2minutes with left side paralysis was admitted to the hospital through EMC. On examination, his vital signs were normal. He was alert and oriented. Brain MRI taken other hospital showed large and irregular well enhancing intra-axial mass in right fronto-parietal area with massive surrounding edema. The signal of lesion was low on T1WI and high on T2WI. The mass was approximately 4cm in diameter and it's boundary was ill defined. The patient was admitted for craniotomy under the impression of malignant intra-axial tumor. Left side paralysis was progressive so we had no choice but to use corticosteroid. After the corticosteroids was given to the patient, the symptom dramatically subsided by several days. The Brain CT showed marked decrease of edema and mass effect. Also the Brain stereotactic MRI showed marked decrease of edema, mass effect and enhancing lesion. Under these findings we had to rule out lymphoma so a stereotactic guided biopsy was performed and revealed a demyelinating lesion consistent with demyelinating pseudotumour. RESULTS : The patient recovered from hemiplegia by high dose corticosteroid treatment over 4 weeks. The Brain MRI confirmed that enhancing lesion as well as cerebral edema disappeared almost completely. Brain MRI taken 3 months after diagnosis showed recurrence of enhancing lesion accompanying severe edema. We've done stereotactic biopsy again to confirm same pathology. The patient is currently und