Acute demyelinating encephalomyelitis masquerading as a tumor

• Main Authors: R Remya, J K Ann, Ani Sreedhar
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2017-01-01
• Series: Kerala Journal of Ophthalmology
• Subjects: Acute demyelinating encephalomyelitis; Cortex broken arc appearance; MR spectroscopy
• Online Access: http://www.kjophthal.com/article.asp?issn=0976-6677;year=2017;volume=29;issue=2;spage=139;epage=141;aulast=Remya

A 34-year-old female presented with a history of acute onset severe bilateral defective vision for 2 weeks. Examination revealed visual acuity CFat1 m in the right eye and 6/60 in the left eye. Right eye had Grade 1 relative afferent pupillary defect. Magnetic resonance imaging (MRI) brain was done which showed well-defined T1-hypointense, T2 and FLAIR hyperintense lesion of approximately 1.8 cm × 1.6 cm × 1.7 cm size in the right frontal lobe cortex and underlying white matter with a thin rim of contrast enhancement with well-defined outer border and a cortex broken arc appearance. MR spectroscopy showed increase in choline peak within the enhancing walls of the lesion and no decrease in N-acetyl aspartate peak suggestive of demyelination. Diagnosis of acute demyelinating encephalomyelitis was made and with a course of large dose steroid vision improved dramatically.