Tumefactive demyelination in older adults: A scoping review of published cases

Tumefactive demyelinating lesions (TDLs) are rare in older populations. In this scoping review we conducted a PUBMED search for published cases of TDLs in patients aged ≥55 years. We identified 31 cases and report data on their presentation, diagnosis, treatment, and outcomes. Motor symptoms were the most common presenting symptoms. Investigations including magnetic resonance imaging (MRI) of the brain and spinal cord, CSF studies, serum autoantibodies and brain positron emission tomography (PET) were used to differentiate TDLs from key differentials including malignancy. Key diagnostic findings were similar to those in younger patients with TDLs, with a slightly higher occurrence of open ring enhancement on MRI (11 cases, 35% in present study; 21% in non-age specified populations), and a lower frequency of unmatched oligoclonal bands (6 cases, 19%; 62% in non-age specified populations). The median time to diagnosis was 30 days with 68% (21 cases) of cases requiring biopsy. Initial treatment involved high dose corticosteroids in 90% of patients (29 cases), with 26% (8 cases) started on an MS disease modifying therapy after the index attack. The median Expanded Disability Status Scale score at presentation was 3 and at last follow up was 2.5 indicating potential for limited recovery from TDL in older patients.