[Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions].

BACKGROUND

Multiple sclerosis (MS) often presents with sensory symptoms, which are usually due to spinothalamic or spinal cord disorders; parietal syndrome is, however, very rare as the initial symptom. Likewise, aphasia is also an infrequent symptom of MS; in the few cases that have been reported, it is usually linked to the existence of important pseudotumoral lesions.

METHODS

We describe the case of a 31-year-old female with a 48-hour history of a progressive clinical picture consisting in nominal aphasia and a sensory parietal syndrome. Magnetic resonance imaging showed a lesion 3.6 cm in diameter that was hyperintense in T2 with perilesional edema and minimal gadolinium uptake, along with other images that revealed increased signal intensity in the periventricular subcortical white matter on the right-hand side and in the left-hand frontal subcortical region. A spectroscopic analysis of the largest lesion revealed that this lesion showed evidence of inflammation, with cell destruction and replacement, although it was not possible to distinguish between a demyelinating disease and a high grade glioma. Hence, a brain biopsy was required in order to reach the final diagnosis of demyelinating pseudotumoral lesion.

CONCLUSIONS

Giant pseudotumoral plaques are a rare form of presenting symptom in MS; use of the clinical features, simple images and spectroscopy is not a very reliable means of reaching a differential diagnosis with a tumour and this often makes it necessary to conduct a biopsy study of the lesion.