This case involves a middle-aged male patient who presented to the hospital with signs of neurological injury. After undergoing imaging studies, doctors discovered the presence of a lesion on the man’s brain, which they elected to biopsy. However, during the biopsy, the patient developed a hemorrhage that resulted in severe and permanent injuries, including left sided paralysis as well as speech defects. It was eventually determined that the man was suffering from multiple sclerosis in addition to his injuries from the biopsy.
Question(s) For Expert Witness
- 1. How frequently do you evaluate and diagnose patients with multiple sclerosis?
2. What is the typical workup for a solitary intracranial lesion causing hemiparesis and speech difficulties?
3. What imaging findings would make you suspicious of tumefactive MS as the underlying cause of such symptoms?
Expert Witness Response E-055292
Tumefactive MS can be very difficult to distinguish from a tumor- as the name implies. This would especially be the case in a middle-aged man. I have sent a handful of such patients for a biopsy and would do so again if necessary. The biggest clue was that a tumefactive lesion was MS (not a real tumor) would be the presence of other lesions. Without seeing the MRI, it is hard to say. But a single, large lesion causing weakness and speech problems sounds typical for a tumor, and biopsies are needed to diagnose these- though the location for this biopsy is not ideal. I would have to see the films myself to judge, but I can imagine many doctors thinking a biopsy is the right thing to do.
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