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Case Reports in Neurological Medicine
Volume 2014 (2014), Article ID 951690, 5 pages
http://dx.doi.org/10.1155/2014/951690
Case Report

Open-Ring Enhancement in Pseudotumoral Multiple Sclerosis: Important Radiological Aspect

1Department of Neurology, Santa Casa de Belo Horizonte, MG, Brazil
2Department of Neurosurgery, Santa Casa de Belo Horizonte, MG, Brazil
3Pathology Service, Clínics Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil

Received 2 February 2014; Accepted 22 March 2014; Published 15 April 2014

Academic Editor: Chin-Chang Huang

Copyright © 2014 Frederico Carvalho de Medeiros et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Observation of open-ring enhancement in magnetic resonance imaging (MRI) is considered a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS). This finding is of great value in the differential diagnosis of tumefactive lesions. Case Report. We describe a 55-year-old white woman, with previous history of ovarian cancer and recent history of fatigue and bilateral retroorbital pain. Important bilateral visual impairment evolved over one month. Physical examination detected the presence of right homonymous hemianopia. Cranial MRI showed an expanding lesion with open-ring enhancement. Given the range of diagnostic possibilities, a stereotactic biopsy was performed, and histopathological examination was consistent with an active demyelinating disease. The patient was treated with 1 g of methylprednisolone and symptoms improved following a significant reduction in the lesion. Conclusions. We highlight the MRI results suggestive of pseudotumoral MS, especially open-ring enhancement, which is an important radiologic aspect to diagnosis and can assist in avoiding unnecessary biopsies.