PMC4009287_01
Cranial MRI showing (a) axial, (b) sagittal, and (c) coronal T1-weighted contrast enhanced views with open-ring enhancement of a hypointense lesion in the parietooccipital region with splenium corpus callosum involvement. (d) Axial FLAIR-weighted image showing hyperintense lesion in the parietooccipital region with extensive splenium corpus callosum involvement. (e) Rim lesions: coronal T2-weighted images showing a hypointensity margin relative to the hyperintensity of the lesion center and periphery.
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A cranial MRI (Figure 1) showed an expansive left temporooccipital lesion extending to the splenium of the corpus callosum, which measured 3.7 x 2.4 x 1.8 cm along its largest axes.
Histological sections of cerebral white matter of pseudotumoral multiple sclerosis. (a) Increased cellularity of the white matter due to infiltration by macrophages. Hematoxylin-eosin. (b) Junction of the normal (left) and demyelinated white matter (right), showing the well-defined limits of the demyelinated area. Luxol fast blue. (c) Relative axonal preservation in the demyelinated area. Immunohistochemistry for neurofilament. (d) Diffuse and perivascular infiltration (arrow) by macrophages. Immunohistochemistry for CD68.
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FLAIR-weighted cranial MRI demonstrating important reduction in the lesion following treatment.
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After six months, a cranial MRI revealed a significant reduction in the lesion (Figure 3).
(a) Sagittal and (b) axial T1-weighted cervical/thoracic MRI showing contrast enhanced lesion at the T2-T3 level.
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T1-weighted cervical/thoracic MRI (Figure 4) showed a lesion at the T2-T3 level. The patient was submitted to additional pulse therapy with 1 g of methylprednisolone for five days and achieved complete remission of all symptoms.