Open-ring enhancement in pseudotumoral multiple sclerosis: important radiological aspect.
Introduction. Observation of open-ring enhancement in magnetic resonance imaging (MRI) is considered a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS). This finding is of great value in the differential diagnosis of tumefactive lesions. Case Report. We describe a 55-year-old white woman, with previous history of ovarian cancer and recent history of fatigue and bilateral retroorbital pain. Important bilateral visual impairment evolved over one month. Physical examination detected the presence of right homonymous hemianopia. Cranial MRI showed an expanding lesion with open-ring enhancement. Given the range of diagnostic possibilities, a stereotactic biopsy was performed, and histopathological examination was consistent with an active demyelinating disease. The patient was treated with 1 g of methylprednisolone and symptoms improved following a significant reduction in the lesion. Conclusions. We highlight the MRI results suggestive of pseudotumoral MS, especially open-ring enhancement, which is an important radiologic aspect to diagnosis and can assist in avoiding unnecessary biopsies.
Department of Neurology, Santa Casa de Belo Horizonte, MG, Brazil.
Frederico Carvalho
FC
de Medeiros
Department of Neurosurgery, Santa Casa de Belo Horizonte, MG, Brazil.
Lucas Alverne Freitas
LA
de Albuquerque
Pathology Service, Clínics Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
Jose Eymard Homem
JE
Pittella
Department of Neurology, Santa Casa de Belo Horizonte, MG, Brazil.
Renata Brant
RB
de Souza
Department of Neurology, Santa Casa de Belo Horizonte, MG, Brazil.
Antonio Pereira
AP
Gomes Neto
Department of Neurology, Santa Casa de Belo Horizonte, MG, Brazil.
Paulo Pereira
PP
Christo