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User:Bzastrow/Tumefactive Multiple sclerosis

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General Outline

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Differences from Multiple Sclerosis

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A very small number of multiple sclerosis cases are considered tumefactive multiple sclerosis (1 in every 1000 multiple sclerosis cases are tumefactive). Multiple Sclerosis is a demyelinating disease, specifically an auto-immune disease where the specific (adaptive) immune system attacks and destroys myelinated axons in the CNS. Tumefactive Multiple Sclerosis is a rare subset of Multiple Sclerosis where demyelination occurs in a specific area of the brain, resulting in an area larger than 2 cm where axons lack myelin.

Clinical Signs and Symptoms

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Symptoms are different for each patient, depending on the location of the demyelination.

Common symptoms include:

  1. Problems processing information
  2. Cognitive dysfunction
  3. Problems with speech and vision
  4. Spasticity - result of demyelination to the efferent motor pathways.
  5. Loss of motor control
  6. Loss of sensation
  7. Often comorbid with depression

Causes/Pathology

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Tumefactive multiple sclerosis is an autoimmune disease that targets oligodendrocytes in the central nervous system, which dramatically affects communication abilities between neuronal connections. Inflammation also occurs, due to a breach in the blood brain barrier, which leads to further damage as a result of inflammation occurring in a closed system.

Epidemiology

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Diagnosis

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Magnetic Resonance Imaging (MRI) - presence of lesions in white matter. Proton MR spectroscopy (H-MRS) detects biochemical changes in the brain, improving pathologic specificity[1] A large brain lesion must be over 2.0 cm in order to be diagnosed as TMS.

Prognosis

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Life expectancy is only 10 years less than that of the average unaffected person. However, quality of life is greatly affected. Couldn't disagree more! I had a tumefactive MS lesion five years ago. It has not turned into full blown MS, I am not on any medication, it has not affected my quality of life and I'm in better shape than before the initial attack. What a joke! My neurologists that I meet with on a yearly basis after my annual MRI feels the chance of recurrance is low and the longer I stay in the remission, the smaller the chance of recurrance.

Management

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References

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  1. ^ Kaeser, Martha A., Frank Scali, Frank P. Lanzisera, and Norman W. Kettner. "Tumefactive Multiple Sclerosis: An Uncommon Diagnostic Challenge." US National Library of Medicine National Institutes of Health. N.p., Mar. 2011. Web. 8 Feb. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110404/>.
  1. Kaeser, Martha A., Frank Scali, Frank P. Lanzisera, and Norman W. Kettner. "Tumefactive Multiple Sclerosis: An Uncommon Diagnostic Challenge." US National Library of Medicine National Institutes of Health. N.p., Mar. 2011. Web. 8 Feb. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110404/>.
  2. Lucchinetti, C. F., R. H. Gavrilova, I. Metz, J. E. Parisi, B. W. Scheithauer, S. Weigand, K. Thomsen, J. Mandrekar, A. Altintas, B. J. Erickson, F. König, C. Giannini, H. Lassmann, L. Linbo, S. J. Pittock, and W. Brück. "Clinical and Radiographic Spectrum of Pathologically Confirmed Tumefactive Multiple Sclerosis." National Center for Biotechnology Information. U.S. National Library of Medicine, 04 June 2008. Web. 13 Feb. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442427/>.
  3. TA, Hardy, and Chataway J. "Tumefactive Demyelination: An Approach to Diagnosis and Management." National Center for Biotechnology Information. U.S. National Library of Medicine, 19 Jan. 2013. Web. 13 Feb. 2013. <http://www.ncbi.nlm.nih.gov/pubmed/23334629>.
  4. AP, Dagher, and Smirniotopoulos J. "Tumefactive Demyelinating Lesions." National Center for Biotechnology Information. U.S. National Library of Medicine, Aug. 1996. Web. 13 Feb. 2013. <http://www.ncbi.nlm.nih.gov/pubmed/8880719>.