Fulminant form of multiple sclerosis simulating brain tumor: A case with parkinsonian features and pathologic study

Maranhão-Filho, Pa.; Moraes Filho, L.; Câmara, L.S.A.; Salema, C.C.

doi:10.1590/S0004-282X1995000300024

Abstracts

We describe the case of a 48 year- old man in whom the clinical features, CT and MR scans were suggestive of a brain tumor but, posteriorly, another MRI study, CSF examination and brain biopsy supported the diagnosis of multiple sclerosis. Interestingly, this patient presented parkinsonian features, probably in connection with the underlying disease.

multiple sclerosis; tumoral form; parkinsonism

Os autores descrevem o caso de um paciente com 48 anos de idade cujos sinais e sintomas, TC e RM foram sugestivos de tumor cerebral mas, posteriormente, nova RM, estudo do LCR e biopsia cerebral sustentaram o diagnóstico de esclerose múltipla. Curiosamente, no transcurso da enfermidade este paciente apresentou parkinsonismo, provavelmente relacionado com a doença de base.

esclerose múltipla; forma tumoral; parkinsonismo

Fulminant form of multiple sclerosis simulating brain tumor. A case with parkinsonian features and pathologic study

Forma fulminante de esclerose múltipla simulando tumor cerebral: um caso com sinais parkinsonianos e estudo patológico

Pa. Maranhão-Filho^I; L. Moraes Filho^II; L.S.A. Câmara^III; C.C. Salema^IV

^INeurologist. Department of Neurosurgery, National Institute of Cancer (INCA). Rio de Janeiro, Brazil

^IINeurosurgeon. Department of Neurosurgery, National Institute of Cancer (INCA). Rio de Janeiro, Brazil

^IIIPathologist. Department of Neurosurgery, National Institute of Cancer (INCA). Rio de Janeiro, Brazil

^IVDepartment of Cardiology, Rocha Faria State Hospital. Rio de Janeiro, Brazil. Department of Neurosurgery, National Institute of Cancer (INCA). Rio de Janeiro, Brazil

SUMMARY

We describe the case of a 48 year- old man in whom the clinical features, CT and MR scans were suggestive of a brain tumor but, posteriorly, another MRI study, CSF examination and brain biopsy supported the diagnosis of multiple sclerosis. Interestingly, this patient presented parkinsonian features, probably in connection with the underlying disease.

Key words:multiple sclerosis, tumoral form, parkinsonism.

RESUMO

Os autores descrevem o caso de um paciente com 48 anos de idade cujos sinais e sintomas, TC e RM foram sugestivos de tumor cerebral mas, posteriormente, nova RM, estudo do LCR e biopsia cerebral sustentaram o diagnóstico de esclerose múltipla. Curiosamente, no transcurso da enfermidade este paciente apresentou parkinsonismo, provavelmente relacionado com a doença de base.

Palavras-chave: esclerose múltipla, forma tumoral, parkinsonismo.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Acknowledgements - We wish to thank Dr. Paulo Fernando de O. Silva and Leticia Lopes de Santana for the pathologic study collaboration; and Dr. Maurice Vincent and Dr. Ana Lucia Z. Rosso for manuscript preparation assistance.

Aceite: 2-março-1995.

Dr. Péricles A Maranhão Filho - Av. Canal de Marapendi 1680/1802 - 22631-050 Rio de Janeiro RJ - Brasil. Fax: 55:21 439-5594.

1. Abbott RJ, Howe JG, Currie S, Holland I. Multiple sclerosis plaque tumor on computed tomography. Br Med J 1982, 285: 1616-1617.
2. Bittencourt PRM, Kendal BE. Computerized axial tomography and diagnosis of multiple sclerosis. Arq Neuropsiquiatr 1983, 41: 171-181.
3. Challiol V. La forme tumorale de la sclerosi an plache. L' Ospedale pschialtrico, 1936, 4: 161-178.
4. Currie S, Urich H. Concurrence of multiple sclerosis and glioma. J Neurol Neurosurg Psychiatry 1974, 37: 598-605.
5. DeAngelis LM. Primary central nervous system lymphoma imitates multiple sclerosis. J Neuro-Oncol 1990, 9: 177-181.
6. Giang DW, Poduri KR, Eskin TA, Ketonen LM, Friedman PA, Wang DD, Herndon RM. Multiple sclerosis masquerading as a mass lesion. Neuroradiology 1992, 34: 150-154.
7. Gütling E, Landis T. CT ring sign imitating tumor, disclosed as multiple sclerosis by MRI: a case report. J Neurol Neurosurg Psychiatry 1989, 52: 903-906.
8. Heimans JJ, DeVisser M, Polman CH, Nauta J, Kamphorst W, Troost D. Accuracy and interobserver variation in the interpretation of computed tomography in solitary brain lesions. Arch Neurol 1990, 47 : 520-523.
9 Hunter SB, Ballinger WE Jr, Rubin JJ. Multiple sclerosis mimicking primary brain tumor. Arch Pathol Lab Med 1987, 111: 464-468.
10. Lecky BRF, Smith NJETS, Foy PM. Cerebral CT lesions in multiple sclerosis mimicking multiple metastases. J Neurol Neurosurg Psychiatry 1991, 54: 92.
11. Mathews T, Moosy J, Salem W. Mixed glioma, multiple sclerosis, and Charcot-Marie-Tooth disease. Arch Neurol 1972, 27: 263-268.
12. Nesbit GM, Forbes GS, Scheithauer BW, Okazaki H, Rodriguez M. Multiple sclerosis: histopathologic and MR and/ or CT correlation in 37 cases at biopsy and three cases at autopsy. Radiology 1991, 180:467-474.
13. Newcombe J, Hawkins CP, Henderson CL, Patel HA. Histopathology of multiple sclerosis lesions detected by magnetic resonance imaging in unfixed postmorten central nervous system tissue. Brain 1991, 114: 1013-1023.
14. Noakes JB, Herkes GK, Frith JA, McLeod JG, Jones MP. Magnetic resonance imaging in clinically-definite multiple sclerosis. Med J Aus 1990, 152: 136-140.
15. Paty DW, McFarlin DE, McDonald WI. Magnetic resonance imaging and laboratory aids in diagnosis of multiple sclerosis (Editorial). Ann Neurol 1991, 29: 3-5.
16. Poser CM, Paty DW, Scheinberg L, McDonald I, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Wallace WT. New diagnostic criteria for multiple sclerosis: guidenes for research protocols. Ann Neurol 1983, 13: 227-231.
17. Prockop LD, Heinz R. Demyelinating disease presenting as an intracranial mass lesion. Arch Neurol 1965, 13: 559-564.
18. Rolak LA, Brown S. Headaches and multiple sclerosis: a clinical study and review of the literature. J Neurol 1990, 237: 300-302.
19. Rolak L. Multiple sclerosis. In Appel S (ed). Current neurology. Chicago: Year Book Med Publ, 1989, 9: 109-148.
20. Sagar HJ, Warlow CP, Sheldon PWE, Esiri MM. Multiple sclerosis with clinical and radiological features of cerebral tumor. J Neurol Neurosurg Psychiatry 1982, 45: 802-808.
21. Vaquero J, Matínez R, Rossi E, López R. Primary cerebral lymphoma: the "ghost tumor". J Neurosurg 1984, 60: 174-176.
22. Vieregge P, Klostermann W , Brückmann H. Parkinsonism in multiple sclerosis. Mov Disord 1992, 7: 380-382.
23. Wallace CJ, Seland TP, Fong TC. Multiple sclerosis: the impact of MR imaging. Am J Radiol 1992, 158: 849-857.
24 Weiner HL, Hafler DA. Multiple sclerosis. In Appel S (ed). Current neurology. Chicago: Year Book Med Publ, 1986, 6: 123-151.
25. Yetkin FZ, Haughton VM, Papke RA, Fischer ME, Rao SM. Multiple sclerosis: specificity of MR for diagnosis. Radiology 1991, 178: 447-451.

Publication Dates

Publication in this collection
09 Dec 2010
Date of issue
Sept 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abbott RJ, Howe JG, Currie S, Holland I. Multiple sclerosis plaque tumor on computed tomography. Br Med J 1982, 285: 1616-1617.

[2] 2. Bittencourt PRM, Kendal BE. Computerized axial tomography and diagnosis of multiple sclerosis. Arq Neuropsiquiatr 1983, 41: 171-181.

[3] 3. Challiol V. La forme tumorale de la sclerosi an plache. L' Ospedale pschialtrico, 1936, 4: 161-178.

[4] 4. Currie S, Urich H. Concurrence of multiple sclerosis and glioma. J Neurol Neurosurg Psychiatry 1974, 37: 598-605.

[5] 5. DeAngelis LM. Primary central nervous system lymphoma imitates multiple sclerosis. J Neuro-Oncol 1990, 9: 177-181.

[6] 6. Giang DW, Poduri KR, Eskin TA, Ketonen LM, Friedman PA, Wang DD, Herndon RM. Multiple sclerosis masquerading as a mass lesion. Neuroradiology 1992, 34: 150-154.

[7] 7. Gütling E, Landis T. CT ring sign imitating tumor, disclosed as multiple sclerosis by MRI: a case report. J Neurol Neurosurg Psychiatry 1989, 52: 903-906.

[8] 8. Heimans JJ, DeVisser M, Polman CH, Nauta J, Kamphorst W, Troost D. Accuracy and interobserver variation in the interpretation of computed tomography in solitary brain lesions. Arch Neurol 1990, 47 : 520-523.

[9] 9 Hunter SB, Ballinger WE Jr, Rubin JJ. Multiple sclerosis mimicking primary brain tumor. Arch Pathol Lab Med 1987, 111: 464-468.

[10] 10. Lecky BRF, Smith NJETS, Foy PM. Cerebral CT lesions in multiple sclerosis mimicking multiple metastases. J Neurol Neurosurg Psychiatry 1991, 54: 92.

[11] 11. Mathews T, Moosy J, Salem W. Mixed glioma, multiple sclerosis, and Charcot-Marie-Tooth disease. Arch Neurol 1972, 27: 263-268.

[12] 12. Nesbit GM, Forbes GS, Scheithauer BW, Okazaki H, Rodriguez M. Multiple sclerosis: histopathologic and MR and/ or CT correlation in 37 cases at biopsy and three cases at autopsy. Radiology 1991, 180:467-474.

[13] 13. Newcombe J, Hawkins CP, Henderson CL, Patel HA. Histopathology of multiple sclerosis lesions detected by magnetic resonance imaging in unfixed postmorten central nervous system tissue. Brain 1991, 114: 1013-1023.

[14] 14. Noakes JB, Herkes GK, Frith JA, McLeod JG, Jones MP. Magnetic resonance imaging in clinically-definite multiple sclerosis. Med J Aus 1990, 152: 136-140.

[15] 15. Paty DW, McFarlin DE, McDonald WI. Magnetic resonance imaging and laboratory aids in diagnosis of multiple sclerosis (Editorial). Ann Neurol 1991, 29: 3-5.

[16] 16. Poser CM, Paty DW, Scheinberg L, McDonald I, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Wallace WT. New diagnostic criteria for multiple sclerosis: guidenes for research protocols. Ann Neurol 1983, 13: 227-231.

[17] 17. Prockop LD, Heinz R. Demyelinating disease presenting as an intracranial mass lesion. Arch Neurol 1965, 13: 559-564.

[18] 18. Rolak LA, Brown S. Headaches and multiple sclerosis: a clinical study and review of the literature. J Neurol 1990, 237: 300-302.

[19] 19. Rolak L. Multiple sclerosis. In Appel S (ed). Current neurology. Chicago: Year Book Med Publ, 1989, 9: 109-148.

[20] 20. Sagar HJ, Warlow CP, Sheldon PWE, Esiri MM. Multiple sclerosis with clinical and radiological features of cerebral tumor. J Neurol Neurosurg Psychiatry 1982, 45: 802-808.

[21] 21. Vaquero J, Matínez R, Rossi E, López R. Primary cerebral lymphoma: the "ghost tumor". J Neurosurg 1984, 60: 174-176.

[22] 22. Vieregge P, Klostermann W , Brückmann H. Parkinsonism in multiple sclerosis. Mov Disord 1992, 7: 380-382.

[23] 23. Wallace CJ, Seland TP, Fong TC. Multiple sclerosis: the impact of MR imaging. Am J Radiol 1992, 158: 849-857.

[24] 24 Weiner HL, Hafler DA. Multiple sclerosis. In Appel S (ed). Current neurology. Chicago: Year Book Med Publ, 1986, 6: 123-151.

[25] 25. Yetkin FZ, Haughton VM, Papke RA, Fischer ME, Rao SM. Multiple sclerosis: specificity of MR for diagnosis. Radiology 1991, 178: 447-451.