Management of Recurrent Tumefactive Multiple Sclerosis: Case Report and Literature Review

Tumefactive multiple sclerosis (MS) is characterized by the presence of a single MS-plaque in the brain. It mimics tumors due to large size, mass effect, and enhancement patterns. Refractory intracranial hypertension due to tumefactive MS requiring decompressive craniectomy (DC) was reported in five cases. However, none of these cases were documented new lesions during the follow-up. We report a case of a 28-year-old female admitted with acute right hemiparesis, headache, and nausea. A brain magnetic resonance imaging (MRI) revealed a left parietal lobe lesion. Within 4 days, she became comatose. Computed tomography (CT) scan revealed the left uncal herniation. DC and resection of the lesion were carried out. Histopathology revealed active demyelinating disease. After 11 years of the first attack, she went to the emergency department due to headache and left hemiparesis. Head CT scan revealed a hypodense area in the right frontal lobe. Three months later, the patient was asymptomatic, and new MRI did not show new lesions.