Recurrent Inflammatory Tumefactive Demyelination—Natural History

ABSTRACT Tumefactive demyelination (TDL) is a rare variant of demyelinating disease characterized by large, tumor‐like brain lesions that can mimic neoplasms, often leading to diagnostic confusion. We report a case of a male in his early forties who presented with focal seizures and a right frontal lobe lesion, initially presumed to be a tumor. Surgical excision revealed inflammatory demyelination. Remarkably, he remained asymptomatic without therapy for 10 years. He later developed progressive right‐sided hemiparesis and visual loss. MRI revealed new lesions in the brainstem and thalamus. Suspecting recurrent tumefactive demyelination, high‐dose corticosteroids were administered, leading to complete recovery. Investigations ruled out neoplasia. This case illustrates the variable natural history of tumefactive demyelination, with the potential for prolonged remission without treatment. Unlike many patients who develop relapsing–remitting multiple sclerosis, some may experience isolated or delayed relapses. Long‐term follow‐up and individualized care are essential, and further studies are needed to guide prognosis and therapy.