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Arnett SV, Prain K, Ramanathan S, Bhuta S, Brilot F, Broadley SA. Long-term outcomes of ADEM-like and tumefactive presentations of CNS demyelination: a case-comparison analysis. J Neurol 2024:10.1007/s00415-024-12349-6. [PMID: 38861035 DOI: 10.1007/s00415-024-12349-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 06/12/2024]
Abstract
A minority of initial multiple sclerosis (MS) presentations clinically or radiologically resemble other central nervous system (CNS) pathologies, acute disseminated encephalomyelitis (ADEM) or tumefactive demyelination (atypical demyelination presentations). With the aim of better defining the long-term outcomes of this group we have performed a retrospective cohort comparison of atypical demyelination versus 'typical' MS presentations. Twenty-seven cases with atypical presentations (both first and subsequent demyelinating events) were identified and compared with typical MS cases. Disease features analysed included relapse rates, disability severity, whole brain and lesion volumes, lesion number and distribution. Atypical cases represented 3.9% of all MS cases. There was considerable overlap in the magnetic resonance imaging (MRI) features of ADEM-like and tumefactive demyelination cases. ADEM-like cases tended to be younger but not significantly so. Atypical cases showed a trend towards higher peak expanded disability severity score (EDSS) score at the time of their atypical presentation. Motor, cranial nerve, cerebellar, cerebral and multifocal presentations were all more common in atypical cases, and less likely to present with optic neuritis. Cerebrospinal fluid (CSF) white cell counts were higher in atypical cases (p = 0.002). One atypical case was associated with peripheral blood myelin oligodendrocyte glycoprotein (MOG) antibodies, but subsequent clinical and radiological course was in keeping with MS. There was no difference in long-term clinical outcomes including annualised relapse rates (ARR), brain volume, lesion numbers or lesion distributions. Atypical demyelination cases were more likely to receive high potency disease modifying therapy early in the course of their illness. Despite the severity of initial illness, our cohort analysis suggests that atypical demyelination presentations do not confer a higher risk of long-term adverse outcomes.
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Affiliation(s)
- Simon V Arnett
- School of Medicine, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia.
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia.
- Griffith university, Gold Coast Campus, Gold Coast, Queensland, Australia.
| | - Kerri Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Faculty of Medicine and Health, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, 2145, Australia
- Department of Neurology, Concord Hospital, Sydney, NSW, 2139, Australia
| | - Sandeep Bhuta
- Department of Neurology, Concord Hospital, Sydney, NSW, 2139, Australia
| | - Fabienne Brilot
- Neuroimmunology Group, Kids Neurosciences Centre, Faculty of Medicine and Health, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, 2145, Australia
| | - Simon A Broadley
- School of Medicine, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
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Muacevic A, Adler JR. Tumefactive Multiple Sclerosis of the Cervical Spinal Cord: A Rare Case Report. Cureus 2020; 12:e6754. [PMID: 32140322 PMCID: PMC7039350 DOI: 10.7759/cureus.6754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tumefactive multiple sclerosis (TMS) is a rare variant of multiple sclerosis (MS) with atypical features that pose a diagnostic challenge. In this study, we report a case of cervical MS in a 19-year-old patient that was diagnosed based on the MRI findings and cerebrospinal fluid analysis. The patient was treated with high-dose steroid and five sessions of plasma exchange with significant improvement.
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