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Monophasic, solitary tumefactive demyelinating lesion: neuroimaging features and neuropathological diagnosis

Departments of ¹ Diagnostic Radiology, ² Pathology and ³ Neurosurgery, Singapore General Hospital, Outram Road, Singapore 168609

The characteristic clinicoradiological findings of multiple sclerosis and acute disseminated encephalomyelitis (ADEM), demonstrating a recurrent progressive course in the former and monophasicity in the latter associated with multiple discrete white matter lesions with variable enhancement on MRI, are not a diagnostic challenge. On the other hand, the less typical radiological presentation of a solitary tumefactive demyelinating lesion mimics a neoplasm, and often necessitates a biopsy. Nonetheless, histopathological examination is an imperfect gold standard and the recognition of certain imaging features may facilitate the correct diagnosis.

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