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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

View larger version (142K): [in a new window]   Figure 1. Contrast-enhanced CT reveals a hypodense lesion in the left parietal subcortical white matter, showing no significant mass effect or enhancement.

View larger version (113K): [in a new window]   Figure 2. (a, b, c) MRI shows high T2, low T1 signal white matter lesion with patchy rim enhancement. The lesion is solitary. Linear high T2 signal in the left periventricular white matter represent a prominent perivascular space on the T2 weighted scan.

View larger version (147K): [in a new window]   Figure 3. Same white matter lesion demonstrates interval increase in rim enhancement 8 days later.

View larger version (150K): [in a new window]   Figure 4. Lesion shows almost complete resolution of rim enhancement 2 months later.

View larger version (88K): [in a new window]   Figure 5. Proton MR spectroscopy showing reduced NAA peak, but no significant elevation of the choline peak.

View larger version (132K): [in a new window]   Figure 6. Haematoxylin and eosin stained sections of brain biopsy showing bizarre astrocytes simulating neoplastic process (original magnification x 200).

View larger version (152K): [in a new window]   Figure 7. The presence of foamy macrophages betray the diagnosis of a demyelinating disorder on histology (Haematoxylin and eosin, original magnification x 100).