A rare case of tumefactive demyelination of brain: A case report and literature review

Abstract

This case report highlights the diagnostic challenges encountered in a 30-year-old female presenting with fever followed by Wernicke's aphasia without right-sided weakness, ultimately diagnosed as tumefactive demyelination (TD). TD is a rare neurological condition often misidentified as brain tumors or inflammatory disorders. The case emphasizes the importance of precise differentiation through advanced magnetic resonance imaging, showing restricted diffusion at lesion edges and the absence of gadolinium enhancement. Accurate diagnosis is crucial for tailored treatment and prognostic assessment. This case contributes to our understanding of TD and underscores the need for continued research and collaboration in the field of rare neurological disorders.

Keywords: Wernicke's aphasia; cerebral spinal fluid (CSF); magnetic resonance imaging (MRI); magnetic resonance spectroscopy (MRS); multiple sclerosis; tumefactive demyelination (TD).

FIGURE 1

Multi‐contrast Magnetic Resonance Imaging (MRI) Showing Mild Diffusion Restriction at the Edges of Brain Lesions Across Fluid Attenuated Inversion Recovery (FLAIR) and T2‐weighted (blue arrows).

FIGURE 2

MRS reveals normal metabolite levels in affected brain regions, providing clarity on NAA, creatine, choline, and lactate concentrations.