T1 post-gad T2 FIR

Diagnosis: Tumefactive multiple sclerosis (Marburg's disease)

This case represents an atypical form of multiple sclerosis known as fulminant monophasic multiple sclerosis, tumefactive multiple sclerosis, or Marburg's disease. Another atypical form of multiple sclerosis is known as Balo concentric sclerosis in which the lesion is tumefactive and enhances but demonstrates a concentric appearance similar to an onion.

Multiple sclerosis is thought to be an autoimmune demeylination and is the most common demyelinating disease after that due to small vessel changes of aging. Women are affected more commonly than men and the typical appearance is ovoid periventricular lesions which are perpendicular to the lateral ventricles with increased T2 signal and decreased T1 signal. Enhancement is variable and depends on the chronicity of the lesion.

The differential of this case is limited due to the classic appearance of a large ring enhancing lesion without mass effect or necrosis with no T2 signal abnormality extending beyond the enhancement, as well as the presence of other with matter lesions. Multiple astrocytomas are a remote possibility. Related Cases

Gharagozloo AM, Poe LB, Collins GH. Antemortem diagnosis of Balo concentric sclerosis: correlative MR imaging and pathologic features. Radiology, Jun 1994; 191(3):p817-9.

Mendez MF, Pogacar S. Malignant monophasic multiple sclerosis or "Marburg's disease." Neurology, Jul 1988; 38(7):p1153-5.

Johnson MD, Lavin P, Whetsell WO. Fulminant monophasic multiple sclerosis, Marburg's type. J Neurol Neurosurg Psychiatry, Oct 1990; 53(10):p918-21.















































Lymphoma Astrocytoma PML