To Biopsy Or Not To Biopsy? That Is the Question (PowerPoint)

Blurred vision; Vertigo; Headache; AphasiaA 16-year old female with an 8-week history of intense vertigo, headache, poor naming, blurred vision and gait instability.VA: 20/20 OU; Bilateral disc edemaMRIDense infiltrate of macrophages associated with interspersed reactive hypertrophic astrocytes and extensive myelin loss.IV Anti-inflammatory agents1. Dastgir J, DiMario FJ. Acute tumefactive demyelinating lesions in a pediatric patient with known diagnosis of multiple sclerosis: review of the literature and treatment proposal. J Child Neurol 2009;24(4):431-7. 2. Kiriyama T, Kataoka H, Taoka T, et al. Characteristic neuroimaging in patients with tumefactive demyelinating lesions exceeding 30 mm. J Neuroimaging 2010;XX:1-9. 3. Malhotra HS, Jain KK, Agarwal A, et al. Characterization of tumefactive demyelinating lesions using MR imaging and in-vivo proton MR spectroscopy. Multiple Sclerosis 2009;15:193-203. 4. Masdeu JC, Quinto C, Olivera C, Tenner M, Leslie D, Visintainer P. Open-ring imaging sign: highly specific for atypical brain demyelination. Neurology 2000;54:1427-1433. 5. Newman NJ, Selzer KA, Bell RA. Association of multiple sclerosis and intracranial hypertension. J Neuro- Ophthalmol. 1994;14:189-192