Page 89 - 14_Atti_SIN_SNO_2022_flip

Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report IV SESSIONE
“LESIONI FOCALI INGANNEVOLI”

Differential diagnosis of multiple sclerosis
and low-grade brain tumors:

case reports and diagnostic challenge

E. MAZZAPICCHI*, S.G. CRISAFULLI**, G. BONOMO*, L. BRAMBILLA**, P. FERROLI*

* Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
** Department of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico
“Carlo Besta”, Milan, Italy

INTRODUCTION weakness the right arm. Except for growth deficit in
childhood and seasonal allergies, his medical history
Multiple sclerosis is the most common immune me- was unremarkable.
diated disease of the central nervous system, with a A brain MR showed a left thalamus-capsular lesion
prevalence in Europe of 108 per 100,000 people. It hyperintense in T2-weighted sequences without con-
most commonly affecting young adults, manifesting trast enhancement with a cystic-necrotic core, wi-
(1)
between 20 and 40 years of age . The diagnosis is of- thout perilesional edema. Spectroscopic analysis of
ten easily made in young people who present with a the lesion showed a reduction of NAA and an increa-
typical demyelinating episode. However, many disor- se in Cho/Cr, suggesting a glial tumor (Figure 1).
ders of the CNS can present with white matter lesions Based on clinical and radiological features, a stereo-
similar to demyelinating lesions, in particular tume- taxic biopsy was performed. Histological examina-
factive lesions, making it a challenging task to differ- tion demonstrated reactive gliosis with infiltrating
entiate them from MS . CNS neoplasms are among CD3+ lymphocytes and foamy histiocytes, consistent
(2,3)
the common MS mimics, often requiring surgical with a demyelinating lesion.
biopsy for a definitive diagnosis . The case was then referred to the Neurology depart-
(4)
In this brief report, we present two cases highlighting ment. Proteins and cell count in CSF were normal;
the challenging differential diagnosis between glio- oligoclonal bands were not present (type 4 pattern).
mas and demyelinating lesions. Serum anti-aquaporin 4 and anti-myelin oligodendro-
cyte glycoprotein antibodies were negative. SEPs,
MEPs and VEPs were normal. After two months, an
CASE REPORT MRI of the spinal cord and brain with double inver-
sion recovery sequence was performed and showed
■ ■ Case 1. In 2015, a 36-year-old man was admitted unchanged thalamic -capsular lesion and no new cor-
to our Institute for a 2-month history of dysgraphia, tical lesions. The patient was then discharged with a
poor coordination of his right hand, and proximal clinical isolated syndrome diagnosis.

Corrispondenza: Dr. Elio Mazzapicchi, UO di Neurologia, Istituto Neurologico C. Besta, via Giovanni Celoria 11, 20133 Milano (MI),
e-mail: elio.mazzapicchi@unimi.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

- 87 -