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Images in Neurology |

Relapsing-Remitting Tumefactive Demyelination

Eva Brandão, MD1; Manuel Melo-Pires, PhD2; Carlos Veira, MD1
[+] Author Affiliations
1Department of Neurology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
2Neuropathology Unit, Centro Hospitalar do Porto, Porto, Portugal
JAMA Neurol. 2014;71(3):366-367. doi:10.1001/jamaneurol.2013.5.
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A previously healthy 26-year-old woman was seen with a progressive left-side weakness lasting 3 days. A brain magnetic resonance imaging (MRI) scan showed a right-sided mass lesion with hyperintensity in fluid-attenuated inversion recovery and T2 sequences, hypointensity in T1, heterogeneous gadolinium enhancement, and no restriction in diffusion-weighted images (Figure 1A-C).

Figure 1. Axial Magnetic Resonance Imaging (MRI)

Axial MRI reveals fluid-attenuated inversion recovery hyperintense lesions (A and B) with gadolinium enhancement (C). Ten months later, a “mirror” image was seen (D and E); gadolinium was not perfused because of her pregnancy (F). Her last MRI revealed residual lesions (G and H) without gadolinium enhancement (I).

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Figure 1.
Axial Magnetic Resonance Imaging (MRI)

Axial MRI reveals fluid-attenuated inversion recovery hyperintense lesions (A and B) with gadolinium enhancement (C). Ten months later, a “mirror” image was seen (D and E); gadolinium was not perfused because of her pregnancy (F). Her last MRI revealed residual lesions (G and H) without gadolinium enhancement (I).

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Figure 2.
Stained Biopsy Sections

A, Hematoxylin-eosin–stained section showing perivenular lymphocytic cuff and edematous white matter. B, Luxol fast blue–stained section showing white matter rarefaction and some perivascular macrophages and lymphocytes around a vessel. Original magnification ×40.

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