{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:05:55Z","timestamp":1789628755703,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2004,10,8]],"date-time":"2004-10-08T00:00:00Z","timestamp":1097193600000},"content-version":"vor","delay-in-days":4298,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[1993,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Thirty\u2010one patients with large, focal cerebral demyelinating lesions are reported. Twenty\u2010four patients had solitary lesions and 7 had multiple foci, the latter apparently of identical age. The lesions presented clinically and radiologically as brain tumors (gliomas or metastases) or as multiple cysts. Six patients were older than 57 years (2 in their 70s) at the onset of their symptoms. The demyelinating nature of the lesions was established through biopsy in each patient and all improved significantly after corticosteroid therapy. Three patients developed additional lesions during the follow\u2010up periods ranging from 9 months to 12 years consistent with the course of multiple sclerosis. Twenty\u2010eight patients did not develop additional lesions. These included 6 patients with multiple lesions at the onset. In 1 of the patients, the first symptoms developed 10 days after receiving vaccination against influenza. Two patients had concomitant malignancy (chronic monomyelogenous leukemia and retroperitoneal seminoma respectively) and 1 patient developed immunoblastic sarcoma in the opposite hemisphere after biopsy diagnosis and steroid treatment of her demyelinating lesion. Tumor\u2010like masses of demyelination may occupy an intermediate position between multiple sclerosis and postinfectious\/postvaccination encephalitis. The clinical course (history of vaccination in one instance, acute onset, good response to corticosteroids, no clinical or radiological evidence of new lesions in the great majority of patients) favored postinfectious\/postvaccination encephalitis. Lesion size however greatly exceeded that of the small foci of perivenous demyelination seen in typical postinfectious\/postvaccination encephalitis and tended to present as space\u2010occupying masses.<\/jats:p>","DOI":"10.1002\/ana.410330105","type":"journal-article","created":{"date-parts":[[2005,1,1]],"date-time":"2005-01-01T12:21:38Z","timestamp":1104582098000},"page":"18-27","source":"Crossref","is-referenced-by-count":305,"title":["Large focal tumor\u2010like demyelinating lesions of the brain: Intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients"],"prefix":"10.1002","volume":"33","author":[{"given":"John J.","family":"Kepes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2004,10,8]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02901445"},{"key":"e_1_2_1_3_2","first-page":"707","volume-title":"A textbook of neurology","author":"Merritt HH","year":"1973"},{"key":"e_1_2_1_4_2","first-page":"132","volume-title":"Manual of basic neuropathology","author":"Poirier J","year":"1990"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.29.2.244"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.41.4.589"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0404.1982.tb06864.x"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1986.00520060084027"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1979.00500440060011"},{"key":"e_1_2_1_10_2","first-page":"307","article-title":"Cranial CT in multiple sclerosis showing a mass effect","volume":"12","author":"Van der Velden M","year":"1979","journal-title":"Surg Neurol"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1981.55.4.0620"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.45.9.802"},{"key":"e_1_2_1_13_2","first-page":"47","article-title":"Unusual CT patterns of multiple sclerosis","volume":"4","author":"Wang A\u2010M","year":"1983","journal-title":"AJNR"},{"key":"e_1_2_1_14_2","first-page":"407","article-title":"Demyelination aigu\u00e9 pseudotumorale \u00e0 pousses regressives","volume":"40","author":"Harpey JP","year":"1983","journal-title":"Arch Fr Pediatr"},{"key":"e_1_2_1_15_2","first-page":"107","article-title":"Schilder's myelinoclastic diffuse sclerosis","volume":"77","author":"Poser CM","year":"1986","journal-title":"Pediatrics"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-198708000-00024"},{"key":"e_1_2_1_17_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1035593"},{"key":"e_1_2_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0387-7604(84)80116-3"},{"key":"e_1_2_1_19_2","first-page":"464","article-title":"Multiple sclerosis mimicking primary brain tumor","volume":"111","author":"Hunter SB","year":"1987","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_2_1_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.52.9.1100"},{"key":"e_1_2_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/0887-8994(89)90024-6"},{"key":"e_1_2_1_22_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.30.5.481"},{"key":"e_1_2_1_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005072-195704000-00001"},{"key":"e_1_2_1_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(89)90218-9"},{"key":"e_1_2_1_25_2","volume-title":"Greenfield's neuropathology","author":"Blackwood W","year":"1967"},{"key":"e_1_2_1_26_2","first-page":"582","volume-title":"Textbook of neuropathology","author":"Raine CS","year":"1991"},{"key":"e_1_2_1_27_2","first-page":"700","article-title":"Bedeutung der stereotaktischen Hirnbiopsie bei atypischer Multipler Sklerose","volume":"60","author":"Braus DF","year":"1989","journal-title":"Nervenarzt"},{"key":"e_1_2_1_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410230422"},{"key":"e_1_2_1_29_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.41.2_Part_1.316"},{"key":"e_1_2_1_30_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.38.7.1153"},{"key":"e_1_2_1_31_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.54.4.288"},{"key":"e_1_2_1_32_2","first-page":"352","article-title":"Cerebral demyelination mimicking intracranial neoplasm","volume":"177","author":"Batnitzky S","year":"1990","journal-title":"Radiology"},{"key":"e_1_2_1_33_2","doi-asserted-by":"publisher","DOI":"10.3109\/15513819109064754"},{"key":"e_1_2_1_34_2","unstructured":"KepesJJ.Large\u2010focal \u201csingle event\u201d demyelinating lesions and their nosological position. 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