A Retrospective, Single Institution Study of Tumefactive Multiple Sclerosis

Background: Tumefactive multiple sclerosis (MS) is an uncommon variant of MS that clinically and radiographically mimics a brain tumor. Risk factors, disease course, and management have not been well established given its rarity. 

Objectives: We describe our institutional experience of tumefactive MS in terms of patient demographics, clinical presentation, treatment, prognosis and radiographic and laboratory correlates. 

Methods: This is an IRB-approved retrospective analysis of adult patients treated for tumefactive multiple sclerosis in our institution between 2004-2017. 

Results: A total of 12 patients (10 females, 2 males) were identified with a mean age of diagnosis at 36.6 years (range 24-52, SD 8.8). Two patients were African American and 10 were Caucasian. Four patients had a previously established diagnosis of MS or a clinically isolated syndrome prior to the development of a tumefactive lesion. The most common sites of brain involvement were the frontal and parietal lobes. Rim enhancement was identified in 10 subjects. Brain biopsy was conducted in 4 cases and 8 patients had cerebral spinal fluid analysis available for review. Treatments and outcomes varied widely. Three cases appeared to have a monophasic course. One patient died from disease progression. 

Conclusions: In our single institutional experience, tumefactive MS has a variable disease course and affects women more often then men. There also is a predilection for frontal and parietal white matter. Treatments, and laboratory correlates will also be presented.