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Neurol India. 2019 Nov-Dec;67(6):1519-1521. doi: 10.4103/0028-3886.273654.

Tumefactive Demyelinating Lesions and Pregnancy.

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S.O.C. Neurologia, Ospedale San Biagio, Piazza Vittime dei Lager Nazifascisti 1, 28845, Domodossola (VB), Italy.
UOC Neurology, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam 9, 00184, Rome, Italy.
Department of Neurology and Psychiatry, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy.
Department of Research, Advanced Diagnostics and Technological Innovation, IRCCS Regina Elena National Cancer Institute, IFO, Via Elio Chianesi 53, 00144, Rome, Italy.
Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, IFO, Via Elio Chianesi 53, 00144, Rome, Italy.


Until now, only one gestational tumefactive demyelinating lesion (TDL) has been described. Here we report two TDL cases occurring during and after the pregnancy. A 26-year-old 6-week pregnant woman developed a 3-cm left frontotemporoparietal subcortical TDL with inhomogeneous partial enhancement. Brain biopsy revealed a subacute demyelinating lesion with abundant macrophages and mild chronic perivascular inflammatory infiltrates. She also had femoralpopliteal deep vein thrombosis. During the 4-year follow-up, magnetic resonance imaging showed only residual biopsied TDL. The second case was a 41-year-woman affected by both multiple sclerosis (MS) and rheumatoid arthritis who developed a 2-cm right anterior corona radiata TDL with sporadic gadolinium-enhancing "annular spots" eight months after delivery. After steroid therapy at the 6-month radiological follow-up, this TDL was half-reduced. Five years earlier, at the beginning of her MS, she already had a 2-cm TDL with incomplete ring enhancement. These two described TDLs formed in prothrombotic conditions and were likely representative of thromboinflammation around and inside the small-medium veins.


Adaptive immunity; immunothrombosis; innate immunity; pregnancy; thromboinflammation; tumefactive demyelinating lesion; tumor

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