{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:26:15Z","timestamp":1792034775248,"version":"4.4.0"},"reference-count":48,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis Journal \u2013 Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>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 \u226555 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.<\/jats:p>","DOI":"10.1177\/20552173261416215","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T10:46:42Z","timestamp":1775213202000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Tumefactive demyelination in older adults: A scoping review of published cases"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2523-9125","authenticated-orcid":false,"given":"Carla","family":"De Pasquale","sequence":"first","affiliation":[{"name":"Hornsby Ku-Ring-Gai Hospital"},{"name":"Northern Beaches Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4145-3172","authenticated-orcid":false,"given":"Todd A.","family":"Hardy","sequence":"additional","affiliation":[{"name":"University of Sydney"},{"name":"University of Sydney"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2017.04.003"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2021.1971077"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.15182"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-016-0626-9"},{"key":"e_1_3_2_6_2","first-page":"69","article-title":"Case series: tumefactive demyelinating lesions: a diagnostic challenge","volume":"53","author":"Fallah A","year":"2010","unstructured":"Fallah A, Banglawala S, Ebrahim S, et al. Case series: tumefactive demyelinating lesions: a diagnostic challenge. Can J Surg 2010; 53: 69\u201370. 2010\/01\/27.","journal-title":"Can J Surg"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.51844"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2024-009"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2021.102816"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2025.106399"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000319"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2022.10.012"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0000000000000427"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.07.013"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2015.327"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/2055217319855755"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/17562864211006503"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2006.05.003"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2023.105408"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458516675748"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2008.145805"},{"key":"e_1_3_2_22_2","first-page":"1759","article-title":"Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis","volume":"131","author":"Lucchinetti CF","year":"2008","unstructured":"Lucchinetti CF, Gavrilova RH, Metz I, et al. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain (London, England : 1878) 2008; 131: 1759\u20131775.","journal-title":"Brain (London, England : 1878)"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2017.08.015"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000527"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2010.06.005"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.49.430"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-019-04197-4"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1012534404328"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-010-5722-1"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5374"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.oa.2018-0287"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.56.7588"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2015-001146"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458513516891"},{"key":"e_1_3_2_35_2","first-page":"1695","article-title":"Single-voxel proton MR spectroscopy of nonneoplastic brain lesions suggestive of a neoplasm","volume":"19","author":"Krouwer HG","year":"1998","unstructured":"Krouwer HG, Kim TA, Rand SD, et al. Single-voxel proton MR spectroscopy of nonneoplastic brain lesions suggestive of a neoplasm. AJNR Am J Neuroradiol 1998; 19: 1695\u20131703.","journal-title":"AJNR Am J Neuroradiol"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.1967"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1191\/1352458505ms1214cr"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11604-008-0273-4"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.radcr.2022.09.008"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1092373"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2015.00150"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.4103\/0028-3886.338642"},{"key":"e_1_3_2_43_2","first-page":"951690","article-title":"Open-ring enhancement in pseudotumoral multiple sclerosis: important radiological aspect","volume":"2014","author":"de Medeiros FC","year":"2014","unstructured":"de Medeiros FC, de Albuquerque LA, Pittella JE, et al. Open-ring enhancement in pseudotumoral multiple sclerosis: important radiological aspect. Case Rep Neurol Med 2014; 2014: 951690.","journal-title":"Case Rep Neurol Med"},{"key":"e_1_3_2_44_2","article-title":"When evaluating a new thyroid mass and a ring-enhancing brain lesion (when two presentations collide)","volume":"8","author":"Nicholas Z","year":"2016","unstructured":"Nicholas Z, Sughrue M, Battiste J, et al. When evaluating a new thyroid mass and a ring-enhancing brain lesion (when two presentations collide). Cureus 2016; 8: e600.","journal-title":"Cureus"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102669"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/neup.12766"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102699"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000004585"},{"key":"e_1_3_2_49_2","first-page":"344","article-title":"Tumefactive multiple sclerosis","volume":"37","author":"Tosuno\u011flu B","year":"2024","unstructured":"Tosuno\u011flu B, \u00c7okal BG, G\u00fcne\u015f HN, et al. Tumefactive multiple sclerosis. Proc (Bayl Univ Med Cent) 2024; 37: 344\u2013347.","journal-title":"Proc (Bayl Univ Med Cent)"}],"container-title":["Multiple Sclerosis Journal \u2013 Experimental, Translational and Clinical"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552173261416215","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552173261416215","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552173261416215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,5]],"date-time":"2026-04-05T13:21:17Z","timestamp":1775395277000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552173261416215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":48,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1177\/20552173261416215"],"URL":"https:\/\/doi.org\/10.1177\/20552173261416215","relation":{},"ISSN":["2055-2173","2055-2173"],"issn-type":[{"value":"2055-2173","type":"print"},{"value":"2055-2173","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"article-number":"20552173261416215"}}