{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:11:26Z","timestamp":1790611886149,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["1R01NS121928"],"award-info":[{"award-number":["1R01NS121928"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe demographic, clinical, and radiographic features of tumefactive demyelination (TD) and identify factors associated with severe attacks and poor outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective review of TD cases seen at Mayo Clinic, 1990\u20132021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 257 patients with TD, 183\/257 (71%) fulfilled the 2017 multiple sclerosis (MS) McDonald criteria at the last follow\u2010up, 12\/257 (5%) had myelin oligodendrocyte glycoprotein antibody\u2010associated disease (MOGAD), 0 had aquaporin\u20104\u2010IgG seropositive neuromyelitis optic spectrum disorders (AQP4+ NMOSD), and 62\/257 (24%) were cryptogenic. Onset before age 18 was present in 18\/257 (7%). Female to male ratio was 1.3:1. Cerebrospinal fluid oligoclonal (CSF) bands were present in 95\/153 (62%). TD was the first demyelinating attack in 176\/257 (69%). At presentation, 59\/126 (47%) fulfilled Barkhof criteria for dissemination in space, 59\/100 (59%) had apparent diffusion coefficient (ADC) restriction, and 57\/126 (45%) had mass effect. Despite aggressive clinical presentation at onset, 181\/257 (70%) of patients remained fully ambulatory (Expanded Disability Status Scale [EDSS] \u22644) after a 3.0\u2010year median follow\u2010up duration. Severe initial attack\u2010related disability (EDSS \u22654) was more common in patients with motor symptoms (81\/143 vs. 35\/106, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), encephalopathy (20\/143 vs. 2\/106, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and ADC restriction on initial MRI (42\/63 vs. 15\/33, <jats:italic>p<\/jats:italic>\u2009=\u20090.04). Poor long\u2010term outcome (EDSS \u22654) was more common in patients with older onset age (41.9\u2009\u00b1\u200915 vs. 36.8\u2009\u00b1\u200915.6, <jats:italic>p<\/jats:italic>\u2009=\u20090.02) and motor symptoms at onset (49\/76 vs. 66\/171, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Most TD patients should be considered part of the MS spectrum after excluding MOGAD and NMOSD. Motor symptoms and older age at presentation portend a poor outcome.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51844","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T03:59:32Z","timestamp":1689307172000},"page":"1544-1555","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Defining the natural history of tumefactive demyelination: A retrospective cohort of 257 patients"],"prefix":"10.1002","volume":"10","author":[{"given":"Mahboubeh","family":"Fereidan\u2010Esfahani","sequence":"first","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester Minnesota USA"},{"name":"Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic  Rochester Minnesota USA"},{"name":"Dell Medical School University of Texas  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A","family":"Decker","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D.","family":"Weigand","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5653-5600","authenticated-orcid":false,"given":"Alfonso S.","family":"Lopez Chiriboga","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eoin P","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester Minnesota USA"},{"name":"Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Laboratory Medicine and Pathology  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan\u2010Mendelt","family":"Tillema","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester Minnesota USA"},{"name":"Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5070-1196","authenticated-orcid":false,"given":"Claudia F","family":"Lucchinetti","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic  Rochester Minnesota USA"},{"name":"Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette E.","family":"Eckel\u2010Passow","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8141-2394","authenticated-orcid":false,"given":"W. 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