Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of multiple sclerosis with a tumefactive lesion during long-term treatment with fingolimod, leading to decompressive craniotomy

Wataru Shiraishi, M.D., Ph.D.1)2), Takeshi Miyata, M.D., Ph.D.3), Ayano Matsuyoshi, M.D.1), Yui Yamada, M.D.4), Taketo Hatano, M.D., Ph.D.3) and Tetsuya Hashimoto, M.D., Ph.D.1)

1) Department of Neurology, Kokura Memorial Hospital
2) Shiraishi Internal Medicine Clinic
3) Department of Neurosurgery, Kokura Memorial Hospital
4) Department of Pathology, Kokura Memorial Hospital

We report a 57-year-old man with multiple sclerosis since his 30s who was treated with fingolimod for 9 years. He developed left hemiparesis and consciousness disturbance. Brain MRI revealed a mass lesion in the right frontal lobe with gadolinium enhancement. Cerebrospinal fluid examination showed no pleocytosis. The lesion continued to expand after admission, and on the 9th day after admission, decompressive craniectomy and brain biopsy were performed. Brain pathology revealed demyelination in the lesion, leading to the diagnosis of a tumefactive demyelinating lesion. Corticosteroid therapy ameliorated the brain lesion, and we inducted natalizumab. Tumefactive demyelinating lesions requiring decompressive craniotomy are rare, and we report this case for the further accumulation of similar cases.
Full Text of this Article in Japanese PDF (4406K)

(CLINICA NEUROL, 63: 37|44, 2023)
key words: decompressive craniotomy, tumefactive demyelinating lesion, multiple sclerosis, fingolimod, brain biopsy

(Received: 1-Sep-22)