title: Tumefactive demyelination-to cracks the nut without cracking the pot.
abstract: A 45-year-old female recently detected diabetic, admitted with difficulty in walking, irrelevant talk and urinary incontinence for 3 weeks and deviation of angle of mouth to left. Examination revealed pallor, delusional thoughts, right upper motor neuron facial weakness, ataxia. CT brain revealed bulky hyperdense lesion in corpus callosum and subsequently MRI of the brain revealed T2-hyperintense lesions involving genu and body of corpus callosum with restricted diffusion, and MR spectroscopy revealed reduced uptake of choline. Possibilities considered were infiltrative glioma of corpus callosum, demyelination and central nervous system lymphoma. As the patient and relatives were not willing to allow stereotactic biopsy, she was started on steroids. Her neurological deficits started improving and 1 month later repeat MRI brain showed a drastic reduction in the size of the lesion. Her neurological condition disappeared and is doing well.
authors.affiliation: Department of Internal Medicine, Medical College Hospital, Thiruvanthapuram, Kerala, India. drcrajasekharan@yahoo.com
authors.forename: C
authors.initials: C
authors.lastname: Rajasekharan
authors.forename: V
authors.initials: V
authors.lastname: Anto
authors.forename: R
authors.initials: R
authors.lastname: Unnikrishnan
mesh_terms: D002794:Choline / Q000378:metabolism; D003337:Corpus Callosum / Q000473:pathology*; D003711:Demyelinating Diseases / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D005938:Glucocorticoids; D002794:Choline; D008775:Methylprednisolone