Tumefactive demyelinating lesions: spectrum of disease, diagnosis and treatment

Whenever MRI imaging depicts typical small, ovoid, well-circumscribed T2 hyperintense lesions scattered across periventricular, iuxtacortical and infratentorial white matter along with a clinical scenario highly suggestive of inflammatory-demyelinating disease of CNS (CNS IID), multiple sclerosis (MS) diagnosis is straightforward. Nevertheless, the expanding role of MRI in MS evaluation is paralleled by increasing recognition of atypical and somewhat misleading radiological scenarios posing considerable diagnostic challenge when occurring in patients without established MS diagnosis. Prompt recognition of imaging features suggestive of demyelination is mandatory to prevent further unnecessary and potentially harmful intervention.