抄録
Patients with tumefactive multiple sclerosis（TMS）manifest various neurological symptoms. However, visual disturbance is uncommon in comparison to multiple sclerosis（MS）. We report a case of TMS with visual loss associated with unilateral optic neuritis and a homonymous visual field defect associated with a tumefactive demyelinating lesion（TDL）in the temporal lobe, without other neurological signs. A-65-year-old man presented visual loss in the left eye 4 weeks after gastric cancer surgery. Visual field testing showed right inferior homonymous quadrantanopia with severe visual field loss in the left eye. MRI revealed left optic neuritis and a 35-mm solitary lesion with open-ring enhancement in the left temporal lobe. Perfusion-weighted imaging（PWI）revealed decreased vascularity in the TDL. Magnetic resonance spectroscopy（MRS）showed demyelinating disease. TMS was suspected rather than a neoplasm based on the MRI, PWI, MRS findings; the left optic neuritis was considered to be associated with the same disease. After corticosteroid therapy, the TDL significantly decreased in size and his visual function showed a partial improvement. Optical coherence tomography showed ganglion cell-inner plexiform layer thinning corresponding to both the left optic neuritis and TDL, which was considered to represent trans-synaptic retrograde degeneration. TMS patients can initially present simultaneous visual loss associated with optic neuritis and homonymous visual field defects associated with a TDL, without any other neurological signs. Conventional MRI and advanced MRI such as PWI and MRS may helpful for the diagnosis. Clinicians should consider the possibility of TMS when optic neuritis occurs with a homonymous visual field defect.
