The diagnostic challenge of differentiating tumefactive multiple sclerosis (TMS) from other brain lesions: a case report and literature review on a rare subtype of MS.

Introduction and importance: This case report is a clinical diagnosis walk through of a rare subtype of multiple sclerosis (MS). It gives an overview of how tumefactive multiple sclerosis (TMS) is systematically narrowed down as the definitive diagnosis. Case presentation: This 29-year-old male patient presented to the emergency department. He collapsed after experiencing pain over his right frontotemporal region followed by a seizure witnessed by his family. Magnetic Resonance Imaging of the brain displayed diffuse enlargement and abnormal T2 weighted and FLAIR hyperintense signals in the diagnostic impressions described by the radiologist of the right temporoparietal region. Clinical discussion: Liquefactive multiple sclerosis, also known as tumefactive multiple sclerosis or Marburg-type multiple sclerosis, is a rare subtype of the neurological disorder that can be difficult to diagnose. Unlike the traditional form of MS, TMS can present as a brain tumor and must be diagnosed with a biopsy rather than via MRI and clinical findings alone. Patients can typically present with headache, cognitive abnormalities, mental confusion, aphasia, apraxia, seizures, and weakness. Here, the authors discuss the presentation, disease diagnosis process and patient management. Conclusion: The patient was stabilized and discharged with a referral to the neurosurgery and neurology departments for outpatient consultation for future clinical management and treatment of their condition.