|
Contributed by Brent T. Harris MD, PhD |
| Department of Pathology (Neuropathology), Dartmouth Medical School |
DIAGNOSIS AND DISCUSSION:
Dx: Subacute demyelinating process
These biopsies show an active demyelinating process. There is no evidence of a neoplasm. Consideration was given for a stroke, though is not felt to be likely given the location of the lesion and overall histologic features. This presentation of a mass lesion with the above described features has been reported (Kepes, J.J. Large focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann. Neurol. 33:18- 27, 1993). In this series, most of the patients had a very favorable clinical outcome following corticosteroid therapy.
This patient recieved immunosuppressive therapy with marked improvement of clinical symptoms and diminished size of the lesion by MRI 6 months after the biopsy.