European Journal of Biomedical and Pharmaceutical Sciences

GLIOBLASTOMA MASQUERADING AS A TUMEFACTIVE DEMYELINATING LESION IN A PATIENT WITH MULTIPLE SCLEROSIS: A CASE REPORT

*Dr. Syeda Nilufar Islam, Prof (Dr.) Parul Dutta, Dr. Nabanita Deka

ABSTRACT

Introduction: Increased incidence of gliomas has been reported in patients with Multiple Sclerosis. Development of new neurological deficits in a patient of Multiple Sclerosis maybe due to relapse of the disease or development of a brain tumor. Distinction between the two is important as a high-grade glioma may mimic a tumefactive demyelinating lesion. Early and correct diagnosis is essential as they have different treatment strategies. Case report: A 30 years old female who was diagnosed to be a case of Multiple Sclerosis at 28years of age and was on oral steroids for 2 years presented to the Neurology OPD with development of new symptoms. She showed good response to oral steroids and was clinically stable until recently when she developed gradually progressive neurological deficits. An MRI brain done subsequently elsewhere gave the diagnosis of tumefactive demyelinating lesion. Based on the symptoms and MRI diagnosis, she was suspected of having a relapse of Multiple Sclerosis, so she was started on IV steroid pulse therapy. However, the symptoms of the patient continued to deteriorate despite IV steroids. An MRI examination of brain was then done in our Institute, based on which a provisional diagnosis of a high-grade glioma was made. The diagnosis was subsequently confirmed by histopathological examination to be a Glioblastoma. Diagnosis: Based on past and present radiological and histopathological findings, a final diagnosis of Glioblastoma with preceding Multiple Sclerosis was made. The patient was planned for tumor debulking surgery, however, she expired 1 day prior to the surgery.

Keywords: Multiple Sclerosis, High-grade glioma, Glioblastoma, Tumefactive demyelinating lesion, Neurological deficit.