Balò’s concentric sclerosis: still to be considered as a variant of multiple sclerosis?

Baló Concentric Sclerosis Mimicking Encephalitis with Seizures and Progressive Aphasia in a 26-Year-Old Woman: A Challenging Diagnostic Dilemma

Introduction

Baló's concentric sclerosis (BCS) is a rare subtype of multiple sclerosis characterized by inflammatory demyelination within the central nervous system.

Case Presentation

This case report presents a challenging diagnostic scenario involving a 26-year-old woman diagnosed with BCS. Despite treatment, her condition did not ameliorate, and magnetic resonance imaging (MRI) findings remained unchanged. A subsequent stereotactic biopsy revealed tumefactive Balo disease, highlighting the intricate diagnostic and therapeutic issues surrounding BCS.

Conclusion

The juxtacortical location of the BCS lesion, as observed in our case, suggests an unfavourable prognosis due to treatment-resistant seizures.

Case Report: Baló's Concentric Sclerosis-Like Lesion in a Patient With Relapsing-Remitting Multiple Sclerosis Treated With Dimethyl Fumarate

Baló's concentric sclerosis (BCS) is a rare demyelinating disorder characterized by acute or subacute neurological symptoms associated with characteristic lesions of concentric onion skin appearance on MRI images and in pathology. The connection between BCS and classic MS is still a subject of debates. Our report presents a case of a patient who developed a symptomatic Baló-like lesion following several years of classical relapsing-remitting multiple sclerosis treated with dimethyl fumarate.

New Onset Nystagmus in a Patient with Multiple Sclerosis

Case Presentation

A 50-year-old male with a history of multiple sclerosis with dizziness and nystagmus presented to the emergency department. On physical exam, nystagmus was noted. Computed tomography of the head without contrast was obtained showing a low density in the left frontal lobe. During admission, magnetic resonance imaging (MRI) findings were consistent with Balò’s concentric sclerosis.

Discussion

Balò’s concentric sclerosis is a rare, inflammatory demyelinating disease, often considered to be an infrequent variant of multiple sclerosis with alternating rings of healthy myelin and demyelination leading to pathognomonic findings of concentric lamella on T2 or contrast-enhanced T1 MRI imaging.

From Baló's concentric sclerosis to multiple sclerosis: a series of 6 patients

INTRODUCTION

Baló's concentric sclerosis (BCS) is a rare CNS disorder characterized by alternating bands of demyelination on MRI. One of the main issues is its relationship with multiple sclerosis (MS).

OBJECTIVES

To describe 6 BCS patients. To review the risk of developing MS in BCS patients.

METHODS

We retrospectively recorded clinical and radiological findings of 6 BCS patients and performed a review of the literature.

RESULTS

Six patients (5 women) with a mean age of 25 years old were included. Main symptoms were hemiparesis/hemihypoesthesia. On MRI, two patients had a single BCS lesion and four had additional MS-like lesions. Alternating bands were usually more visible on DWI. A patient had reduced central perfusion and SWI hypointensity suggestive of a central vein. Oligoclonal bands were identified in 5/6 patients. After 7 years of follow-up, all patients achieved MS criteria with mild disability (mean EDSS 1.75; 0-4). Our literature review included 65 BCS patients from 30 studies: although CSF oligoclonal bands and the presence of additional MS lesions were associated with subsequent relapses, this was not significant.

DISCUSSION/CONCLUSION

Our series allows a detailed MRI description in BCS and gives a new insight into BCS evolution and its strong relationship with MS.