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Neurological Rehabilitation

Rehabilitation of Multiple Sclerosis Relapse with Megacystic Demyelinating Plaque

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 6

    Co-Author(s)

  • Verda S. Mirza, DO

    Resident physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

    • Poster Presenter(s)

  • Benjamin Drukman, MD

    Resident
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

    • Co-Author(s)

  • Ajit Kohli, DO

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Health Sciences University
    Brooklyn, New York

Disclosure(s):
Verda S. Mirza, DO: No financial relationships to disclose
Benjamin Drukman, MD: No financial relationships to disclose
Ajit Kohli, DO: No financial relationships to disclose
Sanjeev Agarwal, MD: No financial relationships to disclose
Case Diagnosis: Multiple Sclerosis with Megacystic Demyelinating Plaque

Case Description or Program Description: A 30-year-old female with asthma, PCOS, and relapsing-remitting multiple sclerosis (RRMS) diagnosed two years ago with residual right eye impairment and right leg weakness presented with worsening vision, difficulty walking, and urinary incontinence.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: MRI showed hyperintense lesions in multiple brain regions and the lower thoracic spine. A new 3.4 cm cystic lesion was noted in the right frontal operculum. Five days of methylprednisolone 1g daily improved urinary continence but did not change leg weakness or vision. Follow-up MRI on day 18 showed no size change but increased edema, while day 29 MRI showed cyst reduction to 2.8 cm, after which she was admitted to acute inpatient rehabilitation.
On admission, she required minimum assistance for bed-to-chair and toilet transfers, moderate assistance for tub transfers, and supervision for bed mobility. She ambulated 150 feet with a rolling walker under close supervision, demonstrating a slow, steady gait with decreased cadence, reduced step length, and intermittent right knee buckling. She had impaired proprioception, light touch, and coordination with right lower extremity (RLE) weakness. By discharge, she achieved modified independence with transfers and continued ambulating with a rolling walker under supervision, managing 150 feet with improved endurance and RLE strength.

Discussion (relevance): Tumefactive Multiple Sclerosis occurs in 1-3 per 1000 MS cases, primarily in RRMS. Lesions are classified as infiltrative, Baló-like, ring-like, or megacystic. Biopsy is needed when diagnosis is unclear or the lesion is unresponsive to treatment of the underlying MS flare. Corticosteroids can reduce lesion size by 45-80%.

Conclusions: Tumefactive MS poses a diagnostic challenge, especially at disease onset. In known MS cases, new cystic lesions may indicate this subtype. Biopsy can be deferred unless the lesion does not respond to acute flare treatment.