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Tumefactive demyelination — SCE Neurology MCQ

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HardMSTumefactive demyelinationSCE Neurology

A 55-year-old man presented with subacute hemiparesis with a large ring-enhancing white-matter lesion. On examination, there was mild aphasia and brisk reflexes but no systemic cancer features. Initial investigations showed: MRI showed incomplete open-ring enhancement and little mass effect for lesion size. Where is the most likely anatomical localisation?

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Correct answer: C — cerebral white matter

The best answer is “cerebral white matter”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Thalamus”, “Peripheral nerve roots”, “Contralateral internal capsule”, “Dominant temporal lobe” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/