The Study Of Demyelinating Psedotumor In Spinal Cord On Clinic, Imaging And Pathology

Objective: To clinically analyze the Magnetic Resonance Imaging and pathologicalfeature of demyelinating psedtumor in spinal cord.Methods: 26 cases were retrospectively analylized over the past 4 years in Yu Huang-ding andYan Tai-shan hospital, whose medical record, MRI, cerebrospinal fluid, electrophysiologycharacteristics and prognosis were evaluated. Among them 5 cases confirmed by pathology afteroperation because of misdiagnosis as tumor had been finished histopathological analysis.Results: Among the 26 cases of demyelinating psedotumor in spinal cord, there were 10 in maleand 16 in female. The onset age was from 13 to 70 years old. 19 cases had acute and subacute coursesand 7 cases had chronic courses. 7 cases had evoked factors, in which 5 relevant to infections. Theclinical presentations mostly consisted of paresthesia and dyskinesia (26/26), with peripheral nervelesion(8/26). Studies of cerebrospinal fluid revealed that leukocyte increased slightly (12/26) andimmune globulin rose (16/26). visual evoke potential(VEP) and brainstem auditory evoked potential(BAEP) were normal (26/26). Nerve conduction velocity step down and wave amplitude decreasedin electromyogram (8/26). MRI showed solitary lesions(21/26) or multiple nodules (5/26),which located in cervical cord (11/26), cervical-thoracic cord (2/26),, thoracic cord (12/26) andlumbar part (1/26). All cases had various degrees of edema and mass effect which were significantin the acute and subacute lesions. 24 cases enhanced by Gd-DTPA in spinal (24/26), the focusshowed patching-shaped or ring-shaped enhanced(23/26), among them 9 cases had openring-like enhanced lesion in the white matter. In histopathology, 5 cases which confirmed bypathology after operation showed inflamlnatory infiltrate, especially a mixture of lymphocytes in theperivascular area and foam macrophages. All cases showed demyelination by luex fast blue stain.After therapy with corticosteroids, their neurological symptoms improved gradually. No relapseoccurred in 24 cases, but 2 cases had been diagnosed clinically definte multiple sclerosis in the follow-up visit.Conclusion: Demyelinating psedotumor in Spinal Cord was often misdiagnosed because it couldpresent as intraspinal neoplasm in clinic or MRI. The segments of cervical and thoracic spinal cordwere usually involved, and few of them peripheral lesion were involved as well. In MRI, theopen-ring sign might be a pathognomonic feature of these lesions. Treatment with corticosteroids washelpful to identify the character of the lesion. In histopathology, we should pay attention to observethe degree of perivascular inflammatory infiltration and myelin loss. Part of them developed tomultiple sclerosis.