Tumefactive Demyelination

Findings:

Axial T1 pre/post contrast and T2 fatsat images demonstrate an ovoid lesion in the right centrum semiovale that is not associated with mass effect. There is incomplete peripheral enhancement of the lesion. The associated T2 hyperintensity does not extend significantly beyond the leading edge of enhancement.

Differential diagnosis:

Demyelination, cerebritis (unusual without mass effect), primary or metastatic neoplasm (enhancement pattern is unusual for these, mass effect would be expected)

Discussion:

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