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Ardakani R, Hatanpaa K, De Los Sanotos Y, Hardeman P, Tardo L. Clinical Problem-Solving: A 19-Year-Old Woman With Progressive Neurological Decline and Multiple Intracranial Lesions. Neurohospitalist 2024; 14:419-422. [PMID: 39308457 PMCID: PMC11412460 DOI: 10.1177/19418744241273283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 09/25/2024] Open
Abstract
The differential diagnosis for multiple intracranial lesions in a young adult is broad and includes demyelinating, neoplastic, and infectious etiologies. In this report, we describe the case of a 19-year-old immunocompetent woman presenting with progressive headaches and aphasia. MRI of the brain revealed multiple, large supratentorial lesions with concentric bands of alternating T2 signal intensities and peripheral contrast enhancement. Cerebrospinal fluid (CSF) analysis was overall bland with negative oligoclonal bands. Serum antibody testing for neuromyelitis optica (NMO) and myelin-oligodendrocyte associated disease (MOGAD) were negative. A broad infectious work-up was also unrevealing. A definitive diagnosis was ultimately obtained after brain biopsy and the patient was started on appropriate therapy. This case highlights a diagnostic framework in evaluating immunocompetent patients presenting with multiple intracranial lesions and progressive neurological decline. The main differential diagnoses for this constellation of radiological and clinical findings are discussed and a literature review is performed on the revealed diagnosis. Lastly, both acute and long-term therapeutic approaches are reviewed.
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Affiliation(s)
- Rumyar Ardakani
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kimmo Hatanpaa
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Paula Hardeman
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lauren Tardo
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
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Fonseca A, Santos E, Taipa R. Baló concentric sclerosis: Literature review and report of two cases. J Neuroimmunol 2024; 392:578370. [PMID: 38797061 DOI: 10.1016/j.jneuroim.2024.578370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/15/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Baló's concentric sclerosis (BCS) is a rare variant of multiple sclerosis characterized by unique pathological features of alternating demyelination and preserved myelin. OBJECTIVES To describe two cases of BCS, radiological and pathological findings and its clinical course. RESULTS We report two distinct cases of BCS that presented with unique MRI findings suggestive of BCS, but with different clinical courses and responses to treatment. The first case demonstrated substantial recovery following corticosteroid therapy, while the second case, initially suspected to be a malignant tumour, showed improvement after surgical intervention and immunoglobulin therapy. CONCLUSION These cases highlight the variability in presentation and course of BCS, underscoring the challenges in diagnosis and the importance of considering BCS in the differential diagnosis of demyelinating and tumefactive lesions. The cases also emphasize the potential for favourable outcomes with appropriate management, challenging the traditional view of BCS as uniformly severe.
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Affiliation(s)
- Angelo Fonseca
- Neurology Department, Hospital Pedro Hispano, ULS-Matosinhos, Portugal.
| | - Ernestina Santos
- Neurology Department, Centro Hospitalar e Universitário de Santo António, Porto, Portugal; UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto Porto Portugal, Portugal; ITR-Laboratory for Integrative and Translational Research in Population Health Porto Portugal, Portugal
| | - Ricardo Taipa
- UMIB-Unit for Multidisciplinary Research in Biomedicine, ICBAS-School of Medicine and Biomedical Sciences, University of Porto Porto Portugal, Portugal; ITR-Laboratory for Integrative and Translational Research in Population Health Porto Portugal, Portugal; Portuguese Brain Bank, Neuropathology Unit, Department of Neurosciences Centro Hospitalar, Universitário do Porto Porto, Portugal
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Zhang YX, Fang GL, Tang JL, Lai QL. Baló's concentric sclerosis with spontaneous remission and favorable prognosis. Heliyon 2024; 10:e33386. [PMID: 39021993 PMCID: PMC11253651 DOI: 10.1016/j.heliyon.2024.e33386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Baló's concentric sclerosis (BCS) is a rare type of central nervous system demyelinating disorder. Most patients with BCS are treated with corticosteroids, and spontaneous remission has seldom been described. Case presentation A 46-year-old man presented with a subacute-onset headache and memory loss. Brain magnetic resonance imaging (MRI) revealed multiple onion-shaped ring lesions with mild enhancement in the outermost ring. A brain biopsy revealed significant myelin loss. The diagnosis of BCS was established based on the MRI results and pathological findings. Interestingly, the patient recovered almost completely without immunotherapy, with repeated brain MRI at the 1-year follow-up showing an obvious reduction in the extent of the lesions. Conclusion Neurologists should improve the recognition of the typical MRI features of BCS to avoid unnecessary biopsies. Although rare, spontaneous remission can be observed in clinical practice.
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Affiliation(s)
- Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, 310003, China
| | - Jin-Long Tang
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, 310013, China
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Czeisler BM. Emergent Management of Central Nervous System Demyelinating Disorders. Continuum (Minneap Minn) 2024; 30:781-817. [PMID: 38830071 DOI: 10.1212/con.0000000000001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article reviews the various conditions that can present with acute and severe central nervous system demyelination, the broad differential diagnosis of these conditions, the most appropriate diagnostic workup, and the acute treatment regimens to be administered to help achieve the best possible patient outcomes. LATEST DEVELOPMENTS The discovery of anti-aquaporin 4 (AQP4) antibodies and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in the past two decades has revolutionized our understanding of acute demyelinating disorders, their evaluation, and their management. ESSENTIAL POINTS Demyelinating disorders comprise a large category of neurologic disorders seen by practicing neurologists. In the majority of cases, patients with these conditions do not require care in an intensive care unit. However, certain disorders may cause severe demyelination that necessitates intensive care unit admission because of numerous simultaneous multifocal lesions, tumefactive lesions, or lesions in certain brain locations that lead to acute severe neurologic dysfunction. Intensive care may be necessary for the management and prevention of complications for patients who have severely altered mental status, rapidly progressive neurologic worsening, elevated intracranial pressure, severe cerebral edema, status epilepticus, or respiratory failure.
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Suzuki D, Suzuki Y, Sato D, Kikuchi K, Akasaka M, Nishida A, Sato K, Koyama S, Nakashima I, Ohta Y. A case of Balò's concentric sclerosis showing the attenuation of the Balò lesion after ofatumumab treatment: A case report. J Neurol Sci 2023; 450:120694. [PMID: 37270900 DOI: 10.1016/j.jns.2023.120694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/07/2023] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Daisuke Suzuki
- Department of Neurology, Nihonkai General Hospital, Yamagata, Japan
| | - Yoshihiro Suzuki
- Department of Neurology, Nihonkai General Hospital, Yamagata, Japan
| | - Daisuke Sato
- Department of Neurology, Nihonkai General Hospital, Yamagata, Japan
| | - Kenji Kikuchi
- Department of Neurology, Nihonkai General Hospital, Yamagata, Japan
| | - Masahiro Akasaka
- Department of Neurosurgery, Nihonkai General Hospital, Yamagata, Japan
| | - Akiko Nishida
- Department of Pathology, Nihonkai General Hospital, Yamagata, Japan
| | - Kazuhiko Sato
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Shingo Koyama
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata, Japan
| | - Ichiro Nakashima
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Yamagata, Japan.
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Shala N, Tolaj I, Jashari F, Malazogu E, Shala A, Bajraktari G, Ahmetgjekaj I, Dreshaj S. Baló Concentric Sclerosis Mimicking Encephalitis with Seizures and Progressive Aphasia in a 26-Year-Old Woman: A Challenging Diagnostic Dilemma. Case Rep Neurol 2023; 15:227-232. [PMID: 37915316 PMCID: PMC10616666 DOI: 10.1159/000534358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
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.
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Affiliation(s)
- Nexhmedin Shala
- Department of Neurological Diseases, University Clinical Centre, Pristina, Kosovo
| | - Ilir Tolaj
- Department of Infectious Diseases, Medical Faculty, Pristina, Kosovo
| | - Fisnik Jashari
- Department of Neurological Diseases, University Clinical Centre, Pristina, Kosovo
| | - Edita Malazogu
- Department of Neurological Diseases, University Clinical Centre, Pristina, Kosovo
| | - Argjend Shala
- Department of Neurological Diseases, University Clinical Centre, Pristina, Kosovo
| | | | - Ilir Ahmetgjekaj
- Department of Radiology, University Clinical Centre, Pristina, Kosovo
| | - Shemsedin Dreshaj
- Department of Infectious Diseases, University Clinical Centre, Pristina, Kosovo
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Li X, Miao X, Wang Y, Sun J, Gao H, Han J, Li Y, Wang Q, Sun C, Liu J. Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations. Front Immunol 2022; 13:1052678. [PMID: 36532021 PMCID: PMC9752826 DOI: 10.3389/fimmu.2022.1052678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To track the clinical outcomes in patients who initially presented with tumefactive demyelinating lesions (TDLs), we summarized the clinical characteristics of various etiologies, and identified possible relapse risk factors for TDLs. Methods Between 2001 and 2021, 116 patients initially presented with TDLs in our hospital were retrospectively evaluated. Patients were followed for relapse and clinical outcomes, and grouped according to various etiologies. Demographic information, clinical data, imaging data, and laboratory results of patients were obtained and analyzed. The risk factors of relapse were analyzed by the Log-Rank test and the Cox proportional hazard model in multivariate analysis. Result During a median follow-up period of 72 months, 33 patients were diagnosed with multiple sclerosis (MS), 6 patients with Balo, 6 patients with neuromyelitis optica spectrum disorders (NMOSD), 10 patients with myelin oligodendrocyte glycoprotein antibody-associated demyelination (MOGAD), 1 patient with acute disseminated encephalomyelitis (ADEM), and the remaining 60 patients still have no clear etiology. These individuals with an unknown etiology were categorized independently and placed to the other etiology group. In the other etiology group, 13 patients had recurrent demyelinating phases, while 47 patients did not suffer any more clinical events. Approximately 46.6% of TDLs had relapses which were associated with multiple functional system involvement, first-phase Expanded Disability Status Scale score, lesions morphology, number of lesions, and lesions location (P<0.05). And diffuse infiltrative lesions (P=0.003, HR=6.045, 95%CI:1.860-19.652), multiple lesions (P=0.001, HR=3.262, 95%CI:1.654-6.435) and infratentorial involvement (P=0.006, HR=2.289, 95%CI:1.064-3.853) may be independent risk factors for recurrence. Relapse free survival was assessed to be 36 months. Conclusions In clinical practice, around 46.6% of TDLs relapsed, with the MS group showing the highest recurrence rate, and lesions location, diffuse infiltrative lesions, and multiple lesions might be independent risk factors for relapse. Nevertheless, despite extensive diagnostic work and long-term follow-up, the etiology of TDLs in some patients was still unclear. And these patients tend to have monophase course and a low rate of relapse.
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Affiliation(s)
- Xinnan Li
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiuling Miao
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yaming Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junzhao Sun
- Senior Department of Neurosurgery, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Haifeng Gao
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| | - Jing Han
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuxin Li
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qingjun Wang
- Department of Radiology, Sixth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
| | - Chenjing Sun
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
| | - Jianguo Liu
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
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Kania K, Ambrosius W, Kozubski W, Kalinowska A. Case Report: Baló's Concentric Sclerosis-Like Lesion in a Patient With Relapsing-Remitting Multiple Sclerosis Treated With Dimethyl Fumarate. Front Neurol 2022; 13:891113. [PMID: 35677328 PMCID: PMC9168072 DOI: 10.3389/fneur.2022.891113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Karolina Kania
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Karolina Kania
| | - Wojciech Ambrosius
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Alicja Kalinowska
- Division of Neurochemistry and Neuropathology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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Al Ashi AK, Meray V, Aziz AM. A Rare Case of Balo Concentric Sclerosis, a Subtype of Tumefactive Multiple Sclerosis, in a 40-Year-Old Male: Case Report. Cureus 2022; 14:e24033. [PMID: 35547427 PMCID: PMC9090231 DOI: 10.7759/cureus.24033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Balo concentric sclerosis (BCS) is a rare sub-variant of multiple sclerosis (MS), a demyelinating disease affecting the CNS. BCS is considered a disease of the brain's white matter with a characteristic tumefactive ring signified with alternating myelinated and demyelinated layers, which gives it an "onion-ring" appearance. Our patient is a 40-year-old male with a past medical history (PMH) of human papillomavirus (HPV) who presented to the hospital with acute onset of progressive horizontal diplopia in the left eye and mild right-sided facial weakness and sensation of heaviness in the head. After ruling out stroke, the patient's clinical presentation prompted further investigation with MRI, MR spectroscopy, and an oligoclonal bands' panel. MRI imaging showed a concentric bullseye area of T1 low signal intensity in the left parietal lobe with surrounding edema vasogenic ring enhancement. MR spectroscopy showed a sequence of incomplete ring-enhancing lesions demonstrating a lactate peak and increased choline. The oligoclonal bands' panel, which revealed negative oligoclonal bands, had elevated IgG in the CSF. The patient was diagnosed with BCS based on the clinical presentation, MRI, MR spectroscopy, and oligoclonal bands' panel findings. The patient was started on high doses of methylprednisolone, which improved his symptoms within 24-48 hours of the initial dose.
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Touma L, Muccilli A. Diagnosis and Management of Central Nervous System Demyelinating Disorders. Neurol Clin 2021; 40:113-131. [PMID: 34798965 DOI: 10.1016/j.ncl.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The spectrum of demyelinating diseases affecting the central nervous system is broad. Although many have a chronic course, neuroinflammatory conditions often present with acute to subacute onset symptoms requiring hospitalization when severe. This article reviews the acute phase assessment and management of these disorders, with a particular focus on multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody disorder, and several atypical demyelinating diseases.
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Affiliation(s)
- Lahoud Touma
- Department of Neurosciences, Unviersity of Montreal, Centre Hospitalier de l'Université de Montréal
| | - Alexandra Muccilli
- Department of Medicine, Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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Deng R, Wu Y, Xu L, Liu K, Huang X, Zhang X. Clinical risk factors and prognostic model for idiopathic inflammatory demyelinating diseases after haploidentical hematopoietic stem cell transplantation in patients with hematological malignancies. Am J Hematol 2021; 96:1407-1419. [PMID: 34350623 DOI: 10.1002/ajh.26312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023]
Abstract
Idiopathic inflammatory demyelinating diseases (IIDDs) of the central nervous system (CNS) are rare but serious neurological complications of haploidentical hematopoietic stem cell transplantation (haplo-HSCT). However, the risk factors and a method to predict the prognosis of post-transplantation CNS IIDDs are not available. This retrospective study first reviewed data from 4532 patients who received haplo-HSCT during 2008-2019 in our center, and 184 patients (4.1%) with IIDDs after haplo-HSCT were identified. Grades II to IV acute graft-versus-host disease (aGVHD) (p < 0.001) and chronic GVHD (cGVHD) (p = 0.009) were identified as risk factors for developing IIDDs after haplo-HSCT. We then divided the 184 IIDD patients into a derivation cohort and validation cohort due to transplantation time to develop and validate a model for predicting the prognosis of IIDDs. In the multivariate analysis of the derivation cohort, four candidate predictors were entered into the final prognostic model: cytomegalovirus (CMV) infection, Epstein-Barr virus (EBV) infection, IgG synthesis (IgG-syn) and spinal cord lesions. The prognostic model had an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.803-0.925) in the internal validation cohort and 0.871 (95% CI: 0.806-0.931) in the external validation cohort. The calibration plots showed a high agreement between the predicted and observed outcomes. Decision curve analysis indicated that IIDD patients could benefit from the clinical application of the prognostic model. The identification of IIDD patients after allo-HSCT who have a poor prognosis might allow timely treatment and improve patient survival and outcomes.
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Affiliation(s)
- Rui‐Xin Deng
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Ye‐Jun Wu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Lan‐Ping Xu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Kai‐Yan Liu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Jun Huang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Hui Zhang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
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Sánchez P, Chan F, Hardy TA. Tumefactive demyelination: updated perspectives on diagnosis and management. Expert Rev Neurother 2021; 21:1005-1017. [PMID: 34424129 DOI: 10.1080/14737175.2021.1971077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tumefactive demyelination (TD) can be a challenging scenario for clinicians due to difficulties distinguishing it from other conditions, such as neoplasm or infection; or with managing the consequences of acute lesions, and then deciding upon the most appropriate longer term treatment strategy. AREAS COVERED The authors review the literature regarding TD covering its clinic-radiological features, association with multiple sclerosis (MS), and its differential diagnosis with other neuroinflammatory and non-inflammatory mimicking disorders with an emphasis on atypical forms of demyelination including acute disseminated encephalomyelitis (ADEM), MOG antibody-associated demyelination (MOGAD) and neuromyelitis spectrum disorders (NMOSD). We also review the latest in the acute and long-term treatment of TD. EXPERT OPINION It is important that the underlying cause of TD be determined whenever possible to guide the management approach which differs between different demyelinating and other inflammatory conditions. Improved neuroimaging and advances in serum and CSF biomarkers should one day allow early and accurate diagnosis of TD leading to better outcomes for patients.
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Affiliation(s)
- Pedro Sánchez
- Department of Neurology, Alexianer St. Josefs-Krankenhaus, Potsdam, Germany
| | - Fiona Chan
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia.,Brain & Mind Centre, University of Sydney, Nsw, Australia
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Martinez HR, Rodriguez-Gonzalez IC, Escamilla-Garza JM, Figueroa-Sanchez JA, Garcia-Aleman AC, Hinojosa-Gonzalez DE. Balo's Concentric Sclerosis with monophasic course: A report of 2 cases. Ann Med Surg (Lond) 2021; 68:102602. [PMID: 34401123 PMCID: PMC8347801 DOI: 10.1016/j.amsu.2021.102602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/15/2021] [Accepted: 07/25/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Balo's Concentric Sclerosis (BCS) is a rare demyelinating disease sometimes considered a variant of multiple sclerosis. It is characterized by an acute or subacute neurological symptoms with characteristic MRI "onion-like" white matter lesions. BCS has a wide range of presentations but is mostly self-limiting. Steroids are indicated in patients with aggressive disease. CASE PRESENTATION We report 2 cases of BCS with monophasic course of stroke-like symptoms and single periventricular concentric lamella with onion-like appearance on MRI without inflammatory reaction in the CSF. They were treated with corticosteroids achieving clinical improvement and without neurological deficit or relapse over the following years. CLINICAL DISCUSSION A number of cases of BCS are described in the literature that show marked recovery with early diagnosis and treatment with steroids. CONCLUSION BCS appears to have a good prognosis when treated early in its diagnosis with steroids.
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Affiliation(s)
- Hector R. Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Mexico
- Neurology and Neurosurgery Institute, Hospital Zambrano Hellion, TecSalud. Tecnologico de Monterrey. Batallón de San Patricio 112, Colonia Real de San Agustin, CP 66278, San Pedro Garza García, N.L, Mexico
| | | | - Juan M. Escamilla-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Mexico
- Neurology and Neurosurgery Institute, Hospital Zambrano Hellion, TecSalud. Tecnologico de Monterrey. Batallón de San Patricio 112, Colonia Real de San Agustin, CP 66278, San Pedro Garza García, N.L, Mexico
| | - Jose A. Figueroa-Sanchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de La Salud, Mexico
- Neurology and Neurosurgery Institute, Hospital Zambrano Hellion, TecSalud. Tecnologico de Monterrey. Batallón de San Patricio 112, Colonia Real de San Agustin, CP 66278, San Pedro Garza García, N.L, Mexico
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Plowman RS, Varma H. Prognostic factors in Tumefactive demyelinating lesions: A retrospective study. J Neurol Sci 2021; 428:117591. [PMID: 34333380 DOI: 10.1016/j.jns.2021.117591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Demyelinating lesions occasionally present as mass-like lesions on imaging, raising concern for malignancy. The disease course of such tumefactive demyelinating lesions (TDLs) is still being defined. METHODS We retrospectively analyzed 21 patients with new-onset neurologic symptoms and mass-like lesions on brain magnetic resonance imaging (MRI), which resulted in biopsy-proven diagnoses of demyelination. 18 patients had a median follow-up of 52 months. The clinical, radiologic and histologic features were associated with disease course. RESULTS An aggressive disease course (ADC) was noted in 33% of the patients and was associated with an initial largest lesion size ≥35 mm (p = 0.0007), mass effect (p = 0.01) and perilesional edema (p = 0.01) on MRI. Age 30 years and older, at presentation (p = 0.05), as well as the absence of a prior tonsillectomy (p = 0.0128) were also associated with an ADC. CONCLUSIONS We identified several factors, including initial larger lesion size, mass effect and perilesional edema on MRI, presentation after 30 years of age and the absence of a prior tonsillectomy, that predict an ADC in patients presenting with TDLs. These predictors of disease course can help guide patient follow-up and stratification for intervention.
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Affiliation(s)
- R Skipper Plowman
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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15
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Baló's concentric sclerosis - A rare entity within the spectrum of demyelinating diseases. J Neurol Sci 2021; 428:117570. [PMID: 34261000 DOI: 10.1016/j.jns.2021.117570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/19/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
Baló's concentric sclerosis (BCS) is a rare, inflammatory demyelinating disease of the central nervous system (CNS). Historically, BCS was thought to be uniformly fatal and diagnosis was based on postmortem findings. With advances in modern neuroimaging, BCS is currently defined by the presence of concentric layered patterns composed of alternating rings of varying intensity. They are best appreciated on gadolinium-enhanced T1-weighted sequences and predominantly occur in the supratentorial cerebral white matter with sparing of cortical U-fibers. The lamellar pattern of the lesions likely reflects bands of demyelination and relative myelin preservation with minimal axonal loss. While BCS falls within the spectrum of atypical demyelinating diseases, there is ongoing debate over whether BCS is a phenotypical variant of multiple sclerosis (MS) or a separate entity. Corticosteroids comprise first-line therapy but there is ongoing controversy regarding appropriate maintenance therapy. First-line MS disease-modifying therapies such as interferon beta-1a are appropriate for patients who fulfill diagnostic criteria for relapsing-remitting MS. Fingolimod should likely be avoided as Baló-like lesions have been reported during its administration or after withdrawal. Monoclonal antibodies such as natalizumab and rituximab are potentially effective at reducing BCS relapses, but alemtuzumab may be relatively ineffective because humoral immunity does not play a central role in BCS pathogenesis.
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16
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Belfkih R, Khayat OG, H'daidane H, El Amrani FZ. Pseudotumoral Demyelinating Lesions: A Presentation of Acute Disseminated Encephalomyelitis. Case Rep Neurol 2021; 13:289-296. [PMID: 34177535 PMCID: PMC8215961 DOI: 10.1159/000515174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 11/21/2022] Open
Abstract
Pseudotumoral forms of demyelination are related to central nervous system demyelinating disorders, usually considered to be an atypical presentation of multiple sclerosis including its different varieties such as Balo's, Schilder's, and Marburg diseases. These lesions could also be seen in myelin oligodendrocyte glycoprotein antibody-associated demyelination, acute disseminated encephalomyelitis (ADEM), and neuromyelitis optica spectrum disorder. The pseudotumoral aspect may be mistakenly considered as an abscess or a cancerous tumor, in which case, patients could endure unnecessary possibly harmful brain biopsy and have a delay in their disease diagnostics and management. Once latter differential diagnosis is discarded, pseudotumoral demyelination prompts uncertainties concerning the nature of the underlying demyelinating condition as prognosis and management differ from multiple sclerosis to other syndromes, especially whether a chronic treatment is needed or not. In this case report, we present a 35-year-old male patient hospitalized in the department of neurology for a rapidly progressive onset of encephalopathy and polyfocal neurological deficits, with pseudotumoral lesions shown on brain MRI. On further investigations, ADEM was the more likely diagnosis that could fit the patient's clinical and radiological presentation. Thence, he was put on high dose of intravenous corticosteroids, with a followed good recovery within the first week of the treatment.
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Affiliation(s)
- Rachid Belfkih
- Neurology Department, University Hospital Center of Tangier-Tetouan-Alhoceima, Tangier, Morocco
| | - Omar Ghomari Khayat
- Neurology Department, University Hospital Center of Tangier-Tetouan-Alhoceima, Tangier, Morocco
| | - Hind H'daidane
- Neurology Department, University Hospital Center of Tangier-Tetouan-Alhoceima, Tangier, Morocco
| | - Fatima Zahra El Amrani
- Neurology Department, University Hospital Center of Tangier-Tetouan-Alhoceima, Tangier, Morocco
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17
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Abstract
Autoimmune inflammatory diseases of the central nervous system (CNS) can be a diagnostic challenge despite advanced imaging techniques. Diagnostic errors can have fatal consequences (e. g. tumefactive lesions) as inappropriate treatment can exacerbate the symptoms of the patients. The aim of this article is to provide help in decision making for selected autoimmune inflammatory diseases of the CNS, in order not to fall into diagnostic traps. The primary focus is on lesions in the neurocranium as inflammatory diseases of the spinal cord were already extensively discussed in a previous article.
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Affiliation(s)
- Armin Bachhuber
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, Geb. 90, 66421, Homburg/Saar, Deutschland.
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18
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Abstract
OBJECTIVE. Tumefactive demyelination mimics primary brain neoplasms on imaging, often necessitating brain biopsy. This article reviews the literature for the clinical and radiologic findings of tumefactive demyelination in various disease processes to facilitate identification of tumefactive demyelination on imaging. CONCLUSION. Both clinical and radiologic findings must be integrated to distinguish tumefactive demyelinating lesions from similarly appearing lesions on imaging. Further research on the immunopathogenesis of tumefactive demyelination and associated conditions will elucidate their interrelationship.
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19
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Jolliffe EA, Guo Y, Hardy TA, Morris PP, Flanagan EP, Lucchinetti CF, Tobin WO. Clinical and Radiologic Features, Pathology, and Treatment of Baló Concentric Sclerosis. Neurology 2021; 97:e414-e422. [PMID: 34011576 DOI: 10.1212/wnl.0000000000012230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/20/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe clinical, radiologic, and pathologic features of Baló concentric sclerosis (BCS) and assess overlap between BCS and other CNS inflammatory demyelinating diseases. METHODS Retrospective review of BCS cases from US and Australian tertiary care centers. RESULTS We identified 40 BCS cases with 38 available MRIs. Solitary MRI lesions were present in 26% (10/38). We saw >1 active concurrent BCS lesion in 45% (17/38). A third (13/38) had multiple sclerosis-suggestive lesions on the index MRI, of which 10 fulfilled Barkhof criteria. In patients with serial MRI performed within 1 month of the index MRI, lesions expanded radially with sequentially increased numbers of T2 hyperintense rings 52% (14/27). Initially nonenhancing or centrally enhancing lesions subsequently developed single or multiple enhancing rings (41%; 9/22) and incomplete enhancing rings (14%; 3/22). Discordance between rings as they appear on apparent diffusion coefficient, diffusion-weighted imaging, and gadolinium-enhanced imaging was observed in 67% (22/33). Aquaporin-4 immunoglobulin G (n = 26) and myelin oligodendrocyte glycoprotein immunoglobulin G (n = 21) were negative in all patients with serum available. Clinical response to steroid treatment was seen in 46% (13/28). A monophasic clinical course was present in 56% (18/32) at last follow-up (median 27.5 months; range 3-100 months). The initial attack was fatal in 10% (4/40). Median time from symptom onset to death was 23 days (range 19-49 days). All 17 patients with pathology available demonstrated typical findings of multiple sclerosis. Patients with active demyelinating lesions all demonstrated oligodendrocytopathy (pattern III). CONCLUSIONS BCS may be a distinct subtype of multiple sclerosis characterized by pattern III immunopathology.
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Affiliation(s)
- Evan A Jolliffe
- From the Departments of Neurology (E.A.J., Y.G., E.P.F., C.F.L., W.O.T.) and Radiology (P.P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (E.A.J.), Capital and Coast District Health Board, Wellington, New Zealand; Brain & Mind Centre (T.A.H.), University of Sydney; and Department of Neurology (T.A.H.), Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Yong Guo
- From the Departments of Neurology (E.A.J., Y.G., E.P.F., C.F.L., W.O.T.) and Radiology (P.P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (E.A.J.), Capital and Coast District Health Board, Wellington, New Zealand; Brain & Mind Centre (T.A.H.), University of Sydney; and Department of Neurology (T.A.H.), Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Todd A Hardy
- From the Departments of Neurology (E.A.J., Y.G., E.P.F., C.F.L., W.O.T.) and Radiology (P.P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (E.A.J.), Capital and Coast District Health Board, Wellington, New Zealand; Brain & Mind Centre (T.A.H.), University of Sydney; and Department of Neurology (T.A.H.), Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - P Pearse Morris
- From the Departments of Neurology (E.A.J., Y.G., E.P.F., C.F.L., W.O.T.) and Radiology (P.P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (E.A.J.), Capital and Coast District Health Board, Wellington, New Zealand; Brain & Mind Centre (T.A.H.), University of Sydney; and Department of Neurology (T.A.H.), Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Eoin P Flanagan
- From the Departments of Neurology (E.A.J., Y.G., E.P.F., C.F.L., W.O.T.) and Radiology (P.P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (E.A.J.), Capital and Coast District Health Board, Wellington, New Zealand; Brain & Mind Centre (T.A.H.), University of Sydney; and Department of Neurology (T.A.H.), Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Claudia F Lucchinetti
- From the Departments of Neurology (E.A.J., Y.G., E.P.F., C.F.L., W.O.T.) and Radiology (P.P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (E.A.J.), Capital and Coast District Health Board, Wellington, New Zealand; Brain & Mind Centre (T.A.H.), University of Sydney; and Department of Neurology (T.A.H.), Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - W Oliver Tobin
- From the Departments of Neurology (E.A.J., Y.G., E.P.F., C.F.L., W.O.T.) and Radiology (P.P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (E.A.J.), Capital and Coast District Health Board, Wellington, New Zealand; Brain & Mind Centre (T.A.H.), University of Sydney; and Department of Neurology (T.A.H.), Concord Repatriation General Hospital, Sydney, NSW, Australia.
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20
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Hoang VT, Trinh CT, Van HAT, Nguyen TTT, Chansomphou V, Pham NTT, Vo MTT, Nguyen HQ, Hoang DT. Balo's Concentric Sclerosis Mimicking Tumor on Magnetic Resonance Imaging in a Young Patient. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:1179547621989673. [PMID: 33786003 PMCID: PMC7960892 DOI: 10.1177/1179547621989673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/04/2021] [Indexed: 12/30/2022]
Abstract
Balo’s concentric sclerosis (BCS) is a rare demyelinating disease known as Multiple Sclerosis (MS) lesion type III. It is a disease of the white matter of the brain characterized by a round lesion with variable concentric myelinated and demyelinated layers, appearing as “onion bulb.” We present a case of BCS and discuss the imaging findings and management strategies of this disease. A 26-y-old male developed headache, weakness, and numbness of limbs. Magnetic resonance imaging (MRI) showed concentric lamellar like demyelinating lesions at the subcortical regions. The patient’s neurological symptoms were consistent with the MRI findings.
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Affiliation(s)
- Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | | | - Hoang Anh Thi Van
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | | | - Vichit Chansomphou
- Department of Radiology, Savannakhet Medical-Diagnostic Center, Kaysone Phomvihane, Lao People's Democratic Republic
| | | | - Minh Tri Thi Vo
- School of Medicine and Pharmacy, The University of Da Nang, Vietnam
| | | | - Duc Thanh Hoang
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
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21
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Torsional Nystagmus and Oscillopsia as Initial Presentation of Balo's Concentric Sclerosis. Can J Neurol Sci 2021; 49:144-145. [PMID: 33685544 DOI: 10.1017/cjn.2021.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Paoletti M, Muzic SI, Marchetti F, Farina LM, Bastianello S, Pichiecchio A. Differential imaging of atypical demyelinating lesions of the central nervous system. Radiol Med 2021; 126:827-842. [PMID: 33486703 DOI: 10.1007/s11547-021-01334-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
The detection of atypical and sometimes aggressive or tumefactive demyelinating lesions of the central nervous system often poses difficulties in the differential diagnosis. The clinical presentation is generally aspecific, related to the location and similar to a number of different lesions, including neoplasms and other intracranial lesions with mass effect. CSF analysis may also be inconclusive, especially for lesions presenting as a single mass at onset. As a consequence, a brain biopsy is frequently performed for characterization. Advanced MRI imaging plays an important role in directing the diagnosis, reducing the rate of unnecessary biopsies and allowing a prompt start of therapy that is often crucial, especially in the case of infratentorial lesions. In this review, the main pattern of presentation of atypical inflammatory demyelinating diseases is discussed, with particular attention on the differential diagnosis and how to adequately define the correct etiology.
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Affiliation(s)
- Matteo Paoletti
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.
| | | | | | - Lisa Maria Farina
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy
| | - Stefano Bastianello
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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23
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Maia C, Novo A, Sousa M, Brás P, Brito O, Rebelo O, Batista S, Sousa L. Tumefactive demyelinating lesions spectrum disorders and the potential role of contemporary disease modifying treatments: a case report. Mult Scler Relat Disord 2020; 47:102669. [PMID: 33302231 DOI: 10.1016/j.msard.2020.102669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 11/15/2022]
Abstract
Marburg disease is a fulminant variant of multiple sclerosis (MS), in which the diagnosis may be particularly difficult and with high rates of mortality. We describe the case of a women with a clinical picture, radiographic features, and neuropathological findings consistent with the classical descriptions of Marburg disease. Initially, our patient did not improved with the acute phase treatments but later showed a good response to natalizumab (NTZ) treatment. This report highlights not only the utility of brain biopsy in the accurate diagnosis of this challenging condition but also the potential role of NTZ as an effective therapeutic option.
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Affiliation(s)
- Carolina Maia
- Medical Image Department, Neuroradiology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Ana Novo
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mário Sousa
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Brás
- Neurology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Olga Brito
- Medical Image Department, Neuroradiology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Olinda Rebelo
- Neuropathology Laboratory, Centro Hospitalar e Universitário de Coimbra, Coimbra
| | - Sónia Batista
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lívia Sousa
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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24
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Boziki M, Sintila SA, Ioannidis P, Grigoriadis N. Biomarkers in Rare Demyelinating Disease of the Central Nervous System. Int J Mol Sci 2020; 21:ijms21218409. [PMID: 33182495 PMCID: PMC7665127 DOI: 10.3390/ijms21218409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/29/2022] Open
Abstract
Rare neurological diseases are a heterogeneous group corresponding approximately to 50% of all rare diseases. Neurologists are among the main specialists involved in their diagnostic investigation. At the moment, a consensus guideline on which neurologists may base clinical suspicion is not available. Moreover, neurologists need guidance with respect to screening investigations that may be performed. In this respect, biomarker research has emerged as a particularly active field due to its potential applications in clinical practice. With respect to autoimmune demyelinating diseases of the Central Nervous System (CNS), although these diseases occur in the frame of organ-specific autoimmunity, pathology of the disease itself is orchestrated among several anatomical and functional compartments. The differential diagnosis is broad and includes, but is not limited to, rare neurological diseases. Multiple Sclerosis (MS) needs to be differentially diagnosed from rare MS variants, Acute Disseminated Encephalomyelitis (ADEM), the range of Neuromyelitis Optica Spectrum Disorders (NMOSDs), Myelin Oligodendrocyte Glycoprotein (MOG) antibody disease and other systemic inflammatory diseases. Diagnostic biomarkers may facilitate timely diagnosis and proper disease management, preventing disease exacerbation due to misdiagnosis and false treatment. In this review, we will describe advances in biomarker research with respect to rare neuroinflammatory disease of the CNS.
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25
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TSPO PET With 18F-GE-180 to Differentiate Variants of Multiple Sclerosis: Relapsing-Remitting Multiple Sclerosis, Tumefactive Demyelination, and Baló's Concentric Sclerosis. Clin Nucl Med 2020; 45:e447-e448. [PMID: 32796248 DOI: 10.1097/rlu.0000000000003220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PET targeting the translocator protein (TSPO) expression is an interesting approach to detect neuroinflammation, as TSPO is upregulated in activated macrophages and microglia. Considering the variable pathophysiology of multiple sclerosis (MS) variants, we compare TSPO PET using F-GE-180 in 3 different demyelinating diseases of the central nervous system: relapsing-remitting MS, tumefactive MS, and Baló's concentric sclerosis. Visualization of neuroinflammation and its PET patterns in addition to MRI may contribute to accurate distinction and monitoring of central nervous system demyelination.
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26
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Hayashida S, Masaki K, Suzuki SO, Yamasaki R, Watanabe M, Koyama S, Isobe N, Matsushita T, Takahashi K, Tabira T, Iwaki T, Kira JI. Distinct microglial and macrophage distribution patterns in the concentric and lamellar lesions in Baló's disease and neuromyelitis optica spectrum disorders. Brain Pathol 2020; 30:1144-1157. [PMID: 32902014 DOI: 10.1111/bpa.12898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/23/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022] Open
Abstract
TMEM119 and purinergic receptor P2Y12 (P2RY12), which are not expressed by recruited peripheral blood macrophages, are proposed to discriminate microglia from macrophages. Therefore, we investigated the distribution patterns of microglia and macrophages in 10 concentric lesions from four autopsied Baló's disease cases and one neuromyelitis optica spectrum disorder (NMOSD) case, using quantitative immunohistochemistry for the markers TMEM119, P2RY12, CD68, CD163 and GLUT5. Three cases with Baló's disease had distal oligodendrogliopathy (DO) showing preferential loss of myelin-associated glycoprotein and early active demyelination in the outermost demyelinating layer (termed DMY-MO). In DMY-MO with DO, TMEM119-positive activated microglia expressing upregulated GLUT5 but markedly downregulated P2RY12 were significantly increased. These activated microglia expressed inducible nitric oxide synthase. Oligodendrocytes and their precursors showed apoptotic-like nuclear condensation in DMY-MO. TMEM119-negative and CD68/CD163-positive macrophages were distributed throughout the lesion center of DMY-MO with DO and these cells demonstrated foamy morphology only in the inner portion but not in the outer portion. In concentric demyelinating lesions from another Baló's case and lamellar demyelinating lesions in an NMOSD case, which had late active demyelination without DO, the densities of TMEM119-, GLUT5- and P2RY12-positive microglia with ramified morphology were significantly increased in myelinated layers but not in demyelinating layers. In particular, in the NMOSD case, TMEM119-positive microglia were confined to the outer portion of the myelinated layers. CD68-positive macrophages with foamy morphology also expressing CD163 accumulated in myelinated as well as in demyelinated layers. These findings suggest that activated microglia expressing TMEM119 and GLUT5, but not P2RY12, are associated with apoptosis of oligodendrocytes in the leading edge of Baló's concentric lesions with DO, whereas TMEM119-, GLUT5- and P2RY12-positive microglia with ramified morphology are associated with myelin preservation in concentric lesions without DO in Baló's disease and NMOSD. These two types of microglia appear to play distinct roles in the formation of concentric lesions.
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Affiliation(s)
- Shotaro Hayashida
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuhisa Masaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi O Suzuki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryo Yamasaki
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sachiko Koyama
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Matsushita
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuya Takahashi
- Department of Neurology, National Hospital Organization Iou Hospital, Kanazawa, Japan
| | - Takeshi Tabira
- Department of Diagnosis, Prevention and Treatment of Dementia, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Toru Iwaki
- Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Translational Neuroscience Center, Graduate School of Medicine, and School of Pharmacy at Fukuoka, International University of Health and Welfare, Ookawa, Japan.,Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, Fukuoka, Japan
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27
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Arenas Vargas LE, Bedoya Morales AM, Rincón Carreño C, Espitia Segura OM, Penagos N. Balo's concentric sclerosis: An atypical demyelinating disease in pediatrics. Mult Scler Relat Disord 2020; 44:102198. [DOI: 10.1016/j.msard.2020.102198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
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28
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Grasso D, Borreggine C, Castorani G, Vergara D, Dimitri LMC, Catapano D, Simeone A, Popolizio T. Balò's concentric sclerosis in a case of cocaine-levamisole abuse. SAGE Open Med Case Rep 2020; 8:2050313X20940532. [PMID: 32733680 PMCID: PMC7370552 DOI: 10.1177/2050313x20940532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/17/2020] [Indexed: 01/15/2023] Open
Abstract
Baló’s concentric sclerosis is a rare variant of multiple sclerosis. It belongs to the group of primary inflammatory central nervous system demyelinating diseases having no clear etiology. Peculiar radiological findings on magnetic resonance imaging are alternating rings of demyelinated and myelinated axons resembling an “onion bulb.” We report on a case of a patient with cocaine abuse who presented with Balò’s-like acute multifocal leukoencephalopathy supported by histological and radiological findings. The abuse of cocaine and its most frequent adulterant, levamisole, may induce ischemic or hemorrhagic stroke and metabolic or multifocal inflammatory leukoencephalopathy. Only a few studies described levamisole-induced leukoencephalopathy mimicking Balò round lesions. Nevertheless, it has not yet been established the correlation between them; it might also be possible that the cocaine/levamisole addiction represents just a coincidence in some of those patients affected by Balò sclerosis disease.
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Affiliation(s)
- Daniela Grasso
- Department of Diagnostic Imaging, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carmela Borreggine
- Department of Diagnostic Imaging, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giulia Castorani
- Diagnostic Imaging, Postgraduate Medical School, University of Foggia, Foggia, Italy
| | - Doriana Vergara
- Department of Diagnostic Imaging, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Domenico Catapano
- Complex Operative Unit of Neurosurgery, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Annalisa Simeone
- Department of Diagnostic Imaging, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Teresa Popolizio
- Department of Diagnostic Imaging, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Ayrignac X, Letourneau-Guillon L, Carra-Dallière C, Duquette P, Girard M, Poirier J, Lahav B, Larochelle C, Prat A. From Baló's concentric sclerosis to multiple sclerosis: a series of 6 patients. Mult Scler Relat Disord 2020; 42:102078. [PMID: 32408148 DOI: 10.1016/j.msard.2020.102078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Xavier Ayrignac
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Département de Neurologie, CRC sclérose en plaques, CHU Montpellier, INSERM, Univ Montpellier, Montpellier, France.
| | - Laurent Letourneau-Guillon
- Département de Radiologie et Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Centre Hospitalier de l'Université de Montréal (CHUM), département de radiologie, radio-oncologie et médecine nucléaire, faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Clarisse Carra-Dallière
- Département de Neurologie, CRC sclérose en plaques, CHU Montpellier, INSERM, Univ Montpellier, Montpellier, France
| | - Pierre Duquette
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Girard
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - José Poirier
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Boaz Lahav
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Catherine Larochelle
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandre Prat
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW To review the clinical findings, differential diagnosis, treatment and outcome of pseudotumoral demyelinating lesions including tumefactive demyelination and Baló's concentric sclerosis. RECENT FINDINGS MRI findings, such as dynamic restricted diffusion changes at the edge of pseudotumoral lesions help to discriminate atypical demyelination from key differential diagnoses, and together with histopathological data, indicate that tissue hypoxia may be important aetiologically. CT-PET imaging can help to distinguish pseudotumoral lesions from high-grade tumours. Although most patients with pseudotumoral lesions have or later develop multiple sclerosis, a proportion will experience a monophasic course or be diagnosed with neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein (MOG) antibody-associated demyelination or acute disseminated encephalomyelitis (ADEM). Many patients with pseudotumoral demyelinating lesions have a favourable prognosis. SUMMARY Not all patients with pseudotumoral lesions require a brain biopsy but close follow-up of biopsied and nonbiopsied lesions is indicated once a diagnosis is established. Testing for AQP4-IgG and MOG-IgG is recommended when a pseudotumoral demyelinating lesion is identified. In the absence of large, prospective studies, it seems reasonable that patients with pseudotumoral lesions who fulfil multiple sclerosis diagnostic criteria are treated with multiple sclerosis therapies.
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31
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Shchepareva ME, Skalnaya AA, Zakharova MN, Shabalina AA. [Clinical and biochemical characteristics of atypical variants of multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:81-86. [PMID: 31934992 DOI: 10.17116/jnevro20191191081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the clinical and biochemical features of atypical variants of multiple sclerosis (MS) (tumefactive demyelination (TD), Balo's concentric sclerosis (BCS)) and acute disseminated encephalomyelitis (ADEM)). MATERIAL AND METHODS Forty-two patients were studied, including 32 patients with atypical variants of MS (6 patients with BCS and 26 patients with TD) and 10 patients with ADEM. The control group included 20 healthy volunteers. Clinical characteristics and EDSS scores were evaluated. Antibodies to aquaporin 1 (AQP1-IgG), aquaporin 4 (AQP4-IgG), antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) and aquaporin 1 (AQP1) in serum and cerebrospinal fluid (CSF) were detected using ELISA. RESULTS AND CONCLUSION BCS and TD occurred both in isolation and comorbid with MS (in 50% of cases with BCS, 50% of cases with TD). Atypical symptoms of MS were detected in 50% of cases of CFS, 15.4% of cases of PD. The levels of CSF cytosis and CSF protein were not significantly different between the groups. The levels of AQP1-IgG, AQP4-IgG, AQP1, MOG-IgG in serum with BCS, TD and ADEM were significantly higher than in the control group. No significant differences were found between atypical variants of MS. A correlation between a high level of MOG-IgG and the EDSS score in BCS was shown. MOG-IgG may have a pathogenetic significance in BCS. Further studies of AQP1-IgG, AQP4-IgG and MOG-IgG in patients with atypical variants of MS are needed.
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32
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Barkhof F, Koeller KK. Demyelinating Diseases of the CNS (Brain and Spine). IDKD SPRINGER SERIES 2020. [DOI: 10.1007/978-3-030-38490-6_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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33
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Ruiz-Sandoval J, Parada-Garza J, Miranda-Garcia L, Lopez-Valencia G, Figueroa-Sanchez M. Acute Disseminated Encephalomyelitis with Baló-like Lesion by Scorpion Sting: Case Report. Neurol India 2020; 68:913-915. [DOI: 10.4103/0028-3886.293487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Yi-Chien Yang
- Department of Neurology (Yang, Tsai), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Neural and Cognitive Sciences (Tsai), China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology (Yang, Tsai), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Neural and Cognitive Sciences (Tsai), China Medical University, Taichung, Taiwan
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35
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Maggi P, Absinta M, Sati P, Perrotta G, Massacesi L, Dachy B, Pot C, Meuli R, Reich DS, Filippi M, Pasquier RD, Théaudin M. The "central vein sign" in patients with diagnostic "red flags" for multiple sclerosis: A prospective multicenter 3T study. Mult Scler 2019; 26:421-432. [PMID: 31536435 DOI: 10.1177/1352458519876031] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective. OBJECTIVES To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases. METHODS In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory "red flags" (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed. RESULTS Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value. CONCLUSION The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
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Affiliation(s)
- Pietro Maggi
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland/ Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA/ Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Gaetano Perrotta
- Department of Neurology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Luca Massacesi
- Department of Neuroscience, Psychology, Drug and Child Health (NEUROFARBA), University of Florence, Florence, Italy/ Multiple Sclerosis Center, Department of Neurology 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Bernard Dachy
- Department of Neurology, Hopital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Pot
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Massimo Filippi
- Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy/ Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Renaud Du Pasquier
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Théaudin
- Department of Neurology, Center of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
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Kchaou M, Nagi S, Echebbi S, Ben Ali N, Fray S, Jamoussi H, Mohamed F. MRI study of Baló’s concentric sclerosis before and after corticosteroid therapy. Rev Neurol (Paris) 2019; 175:327-329. [DOI: 10.1016/j.neurol.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/25/2022]
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37
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Pathologic and MRI analysis in acute atypical inflammatory demyelinating lesions. J Neurol 2019; 266:1743-1755. [DOI: 10.1007/s00415-019-09328-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 01/15/2023]
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38
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Ueno H, Norose K, Kamimura T, Mihara K, Yamasaki F, Hikosaka K, J Amatya V, Takeshima Y, Kurisu K, Maruyama H. Metastatic Malignant Lymphoma Mimicking Cerebral Toxoplasmosis with the "Target Sign". Intern Med 2019; 58:1157-1162. [PMID: 30568116 PMCID: PMC6522404 DOI: 10.2169/internalmedicine.1156-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We herein report the case of a 60-year-old man with a "target sign" in the left frontal lobe on magnetic resonance imaging (MRI), which is thought to be a specific sign of cerebral toxoplasmosis. 18F-fluorodeoxyglucose-positron emission tomography showed no increased uptake, and 201Tl-single photon emission computed tomography showed the focal uptake in the left frontal lesion. On a brain biopsy, the patient was given a definitive diagnosis of brain metastasis from diffuse large B-cell lymphoma, and cerebral toxoplasmosis was excluded. In the present case, multilayer intensities on MRI may reflect the fast-growing nature of this tumor.
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Affiliation(s)
- Hiroki Ueno
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazumi Norose
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Japan
| | - Teppei Kamimura
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Keichiro Mihara
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kenji Hikosaka
- Department of Infection and Host Defense, Graduate School of Medicine, Chiba University, Japan
| | - Vishwa J Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
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39
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Ertuğrul Ö, Çiçekçi E, Tuncer MC, Aluçlu MU. Balo’s concentric sclerosis in a patient with spontaneous remission based on magnetic resonance imaging: A case report and review of literature. World J Clin Cases 2018; 6:447-454. [PMID: 30294609 PMCID: PMC6163147 DOI: 10.12998/wjcc.v6.i11.447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 02/05/2023] Open
Abstract
Balo’s concentric sclerosis (BCS) is a rare monophasic demyelinating disease known as multiple sclerosis subtype and seen as a round lesion with variable hyper and hypo-detoxification layers. Characteristic appearance can be seen as “bulb eye” or “onion bulb”. The initial terminology for this neurological disorder was leukoencephalitis periaxialis concentrica; this is defined as a disease in which the white matter of the brain is destroyed in concentric layers in such a way as to leave the axial cylinders intact. This report presents a case of BCS with spontaneous healing of the patient and a mass lesion with concentric rings adjacent to the left lateral ventricle and the posterior portion of the corpus callosum with peripheral vasogenic edema. The neurological lesion of the patient was similar to the magnetic resonance imaging and clinical findings of the BCS.
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Affiliation(s)
- Özgür Ertuğrul
- Department of Radiology, Memorial Hospital, Diyarbakır 21100, Turkey
| | - Esra Çiçekçi
- Department of Physiotherapy, University of Health Sciences, Gazi Yaşargil Education and Research Hospital, Diyarbakır 21100, Turkey
| | - Mehmet Cudi Tuncer
- Department of Anatomy, Faculty of Medicine, University of Dicle, Diyarbakır 21280, Turkey
| | - Mehmet Ufuk Aluçlu
- Department of Neurology, Faculty of Medicine, University of Dicle, Diyarbakır 21280, Turkey
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40
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Behrens JR, Wanner J, Kuchling J, Ostendorf L, Harms L, Ruprecht K, Niendorf T, Jarius S, Wildemann B, Gieß RM, Scheel M, Bellmann-Strobl J, Wuerfel J, Paul F, Sinnecker T. 7 Tesla MRI of Balo's concentric sclerosis versus multiple sclerosis lesions. Ann Clin Transl Neurol 2018; 5:900-912. [PMID: 30128315 PMCID: PMC6093849 DOI: 10.1002/acn3.572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/18/2018] [Accepted: 04/06/2018] [Indexed: 12/20/2022] Open
Abstract
Background Baló's concentric sclerosis (BCS) is a rare condition characterized by concentrically layered white matter lesions. While its pathogenesis is unknown, hypoxia‐induced tissue injury and chemotactic stimuli have been proposed as potential causes of BCS lesion formation. BCS has been suggested to be a variant of multiple sclerosis (MS). Here, we aimed to elucidate similarities and differences between BCS and MS by describing lesion morphology and localization in high‐resolution 7 Tesla (7 T) magnetic resonance imaging (MRI) scans. Methods Ten patients with Baló‐type lesions underwent 7 T MRI, and 10 relapsing remitting MS patients served as controls. The 7 T MR imaging protocol included 3D T1‐weighted (T1w) magnetization‐prepared rapid gradient echo, 2D high spatial resolution T2*‐weighted (T2*w) fast low‐angle shot and susceptibility‐weighted imaging. Results Intralesional veins were visible in the center of all but one Baló‐type lesion. Four Baló‐type lesions displayed inhomogeneous intralesional T2*w signal intensities, which are suggestive of microhemorrhages or small ectatic venules. Eight of 10 BCS patients presented with 97 additional lesions, 36 of which (37%) had a central vein. Lesions involving the cortical gray matter and the U‐fibers were not detected in BCS patients. Conclusion Our findings support the hypothesis that BCS and MS share common pathogenetic mechanisms but patients present with different lesion phenotypes.
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Affiliation(s)
- Janina R Behrens
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Julia Wanner
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Joseph Kuchling
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Lennard Ostendorf
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Lutz Harms
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Clinical and Experimental Multiple Sclerosis Research Center Charite - Universitätsmedizin Berlin Berlin Germany
| | - Klemens Ruprecht
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Clinical and Experimental Multiple Sclerosis Research Center Charite - Universitätsmedizin Berlin Berlin Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany.,Experimental and Clinical Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group Department of Neurology University of Heidelberg Heidelberg Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group Department of Neurology University of Heidelberg Heidelberg Germany
| | - René M Gieß
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Michael Scheel
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Judith Bellmann-Strobl
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany.,Experimental and Clinical Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Jens Wuerfel
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Medical Image Analysis Center (MIAC AG) Basel Switzerland.,qbig Department of Biomedical Engineering University Basel Basel Switzerland
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany.,Clinical and Experimental Multiple Sclerosis Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Experimental and Clinical Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Tim Sinnecker
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Medical Image Analysis Center (MIAC AG) Basel Switzerland.,Department of Neurology Universitätsspital Basel Basel Switzerland
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Amini Harandi A, Esfandani A, Pakdaman H, Abbasi M, Sahraian MA. Balo’s concentric sclerosis: an update and comprehensive literature review. Rev Neurosci 2018; 29:873-882. [DOI: 10.1515/revneuro-2017-0096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/10/2018] [Indexed: 12/17/2022]
Abstract
Abstract
Balo’s concentric sclerosis (BCS) is considered a variant of multiple sclerosis characterized by concentric lamella of alternating demyelinated and partially myelinated tissues. It is a rare and a relatively acute condition. Attacks may proceed rapidly over weeks or months, typically without remission, like Marburg’s variant, resulting in death or severe disability. However, the majority of cases have a more benign, self-limiting course with spontaneous remission. Magnetic resonance imaging is a primary imaging modality in the diagnosis of BCS. Treatment with intense immunosuppression may be indicated in patients with more aggressive form. New reports reveal more evidence regarding the pathophysiology and treatment strategies.
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Affiliation(s)
- Ali Amini Harandi
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Akram Esfandani
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Hossein Pakdaman
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Mehdi Abbasi
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute , Tehran University of Medical Sciences , Tehran 1136746911 , Iran
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Jarius S, Würthwein C, Behrens JR, Wanner J, Haas J, Paul F, Wildemann B. Baló's concentric sclerosis is immunologically distinct from multiple sclerosis: results from retrospective analysis of almost 150 lumbar punctures. J Neuroinflammation 2018; 15:22. [PMID: 29347989 PMCID: PMC5774135 DOI: 10.1186/s12974-017-1043-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Baló’s concentric sclerosis (BCS) is a rare inflammatory demyelinating disorder of the central nervous system characterised by concentric layers of demyelination. It is unclear whether BCS is a variant of multiple sclerosis (MS) or a disease entity in its own right. Objective To compare the cerebrospinal fluid (CSF) features of BCS to those of MS. Methods Retrospective analysis of the CSF profile of all patients with BCS reported in the medical literature between 1980 and 2017. Results In total, the results of 146 lumbar punctures (LP) in 132 patients were analysed. The most striking finding was a lack of CSF-restricted oligoclonal bands (OCB) in 66% (56/85) of all LP in the total BCS group, in 74% (14/19) in the subgroup of patients with both MRI and histological evidence for BCS, and in 82% (18/22) in the subgroup of patients with highest radiological confidence (high MRI quality, ≥ 3 layers of demyelination). OCB disappeared in 1/2 initially OCB-positive patients. These findings are in stark contrast to MS, in which OCB are present in ≥ 95% of patients and are thought to remain stably detectable over the entire course of disease (p < 0.000001). OCB frequency was low both in ‘historic’ patients (1980–2009; 37%) and in more recent patients (2010–2017; 31%). OCB-positive and OCB-negative patients did not differ significantly with regard to age, sex, disease duration, number of Baló-like lesions on MRI, number of relapses, treatment or final outcome. In accordance with the high rate of OCB negativity, Link’s IgG index was negative in 63% of all tested samples (p < 0.000001 vs. MS). CSF pleocytosis was present in 28% (27/96; p < 0.000001 vs. MS) and elevated CSF total protein levels in 41% (31/76) of samples. Conclusion OCB and IgG index frequencies in BCS are much more similar to those reported in neuromyelitis optica or myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis than to those in MS. Our findings suggest that in most cases, BCS-like lesions denote the presence of a disease entity immunologically distinct from MS. In addition, we provide data on the demographics, clinical course and radiological features of BCS based on the largest cohort analysed to date.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - C Würthwein
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - J R Behrens
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Wanner
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - F Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Abstract
PURPOSE OF REVIEW This article focuses on neuroimaging in multiple sclerosis (MS), the most common central nervous system (CNS) demyelinating disorder encountered by practicing neurologists. Less common adult demyelinating disorders and incidental subclinical white matter abnormalities that are often considered in the differential diagnosis of MS are also reviewed. RECENT FINDINGS Advancements in neuroimaging techniques, eg, the application of ultrahigh-field MRI, are rapidly expanding the use of neuroimaging in CNS demyelinating disorders. Probably the most important recent findings include the detection of cortical lesions and CNS atrophy even in early stages of MS. The key development for practicing neurologists is the growing impact of MRI on the diagnostic criteria for MS and neuromyelitis optica (NMO) spectrum disorders. SUMMARY MRI serves as an important component of the diagnostic criteria for MS and other major CNS demyelinating disorders, and it has been established as a reliable and sensitive indicator of disease activity and progression. In addition, rapidly advancing neuroimaging techniques are helping to improve our understanding of disease pathogenesis.
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Agarwal M, Ulmer JL, Klein AP, Mark LP. Why Is This Auntminnie a Diagnostic Conundrum?: A Knowledge-Based Approach to Balo's Concentric Sclerosis From Reports of 3 Cases and Pooled Data From 68 Other Patients in the Literature. Curr Probl Diagn Radiol 2018; 48:415-422. [PMID: 29428181 DOI: 10.1067/j.cpradiol.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We came across 3 cases of Balo's concentric sclerosis (BCS). The first of these patients presented to an outside hospital and was transferred to our institution due to complications resulting from a biopsy. The other 2 patients, despite having a characteristic imaging appearance and despite insistence on our part on the diagnosis of BCS, underwent a surgical procedure, which could have been prevented. This led us to review the available literature on BCS. MATERIAL AND METHODS A total of 68 patients diagnosed with BCS between 1995 and 2015 were studied and the data collected for the clinical presentation and course, imaging, spinal fluid analysis, treatment, and clinical and imaging outcome. CONCLUSIONS A 25% surgery rate (biopsy or resection) was found in the study. We concluded that this relatively high surgery rate in this auntminnie nonsurgical disease is multifactorial; and includes factors like nonfamiliarity with the disease, anxiety on the part of patients and physicians, due to a sometimes rapidly deteriorating clinical picture; and resemblance of the disease with other entities such as tumor and infection. However, characteristic imaging appearance combined with acute or subacute presentation and dramatic improvement in clinical status after high-dose steroid chemotherapy; are highly suggestive of the disease, and can prevent unnecessary surgery.
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Affiliation(s)
- Mohit Agarwal
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI.
| | - John L Ulmer
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew P Klein
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
| | - Leighton P Mark
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
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Sagduyu Kocaman A, Yalinay Dikmen P, Karaarslan E. Cocaine-induced multifocal leukoencephalopathy mimicking Balo's concentric sclerosis: A 2-year follow-up with serial imaging of a single patient. Mult Scler Relat Disord 2017; 19:96-98. [PMID: 29182995 DOI: 10.1016/j.msard.2017.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/23/2017] [Accepted: 11/12/2017] [Indexed: 01/21/2023]
Abstract
Cocaine abuse may cause stroke, metabolic or multifocal inflammatory leukoencephalopathy. We described a patient with cocaine abuse who presented with Balo's type acute multifocal leukoencephalopathy. Magnetic Resonance Imaging (MRI) of the brain showed onion like patchy concentric ring enhancement on T1-weighted MRI with gadolinium. Balo's Concentric Sclerosis like radiological findings related to cocaine has not been reported. Levamisole is now frequently used as an ingredient in cocaine and may cause leukoencephalopathy. It is recommended to check urine levamisole levels in patients with cocaine-induced leukoencephalopathy with or without mimicking Balo's Concentric Sclerosis. On the other hand, it is also possible that the cocaine use was coincidental and this was a demyelinating case arising de novo in patient who uses cocaine.
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Affiliation(s)
- Ayse Sagduyu Kocaman
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Neurology Department, Turkey.
| | - Pinar Yalinay Dikmen
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Neurology Department, Turkey
| | - Ercan Karaarslan
- Acibadem Mehmet Ali Aydinlar University, School of Medicine, Radiology Department, Turkey
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Kizilca Ö, Öztek A, Kesimal U, Şenol U. Signs in Neuroradiology: A Pictorial Review. Korean J Radiol 2017; 18:992-1004. [PMID: 29089832 PMCID: PMC5639165 DOI: 10.3348/kjr.2017.18.6.992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/02/2017] [Indexed: 01/08/2023] Open
Abstract
One of the major problems radiologists face in everyday practice is to decide the correct diagnosis, or at least narrow down the list of possibilities. In this context, indicative evidences (signs) are useful to recognize pathologies, and also to narrow the list of differential diagnoses. Despite classically being described for a single disease, or a closely related family of disorders, most indications are not restricted exclusively to their traditional definition. Therefore, using signs for prognosis requires knowledge of the mechanism of their appearance, and which pathologies they are observed in. In this study, we demonstrate some of the more common and useful neuroradiologic signs with relevant images, and discuss their use in differential diagnosis.
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Affiliation(s)
- Özgür Kizilca
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Alp Öztek
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Uğur Kesimal
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Utku Şenol
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Hardy TA, Corboy JR, Weinshenker BG. Baló concentric sclerosis evolving from apparent tumefactive demyelination. Neurology 2017; 88:2150-2152. [DOI: 10.1212/wnl.0000000000003990] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/02/2017] [Indexed: 01/08/2023] Open
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Vedrenne N, Sarrazy V, Richard L, Bordeau N, Battu S, Billet F, Desmoulière A. Isolation of Astrocytes Displaying Myofibroblast Properties and Present in Multiple Sclerosis Lesions. Neurochem Res 2017; 42:2427-2434. [PMID: 28434162 DOI: 10.1007/s11064-017-2268-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/14/2017] [Accepted: 04/12/2017] [Indexed: 12/16/2022]
Abstract
A wide heterogeneity of lesions can affect the central nervous system (CNS). In all situations where neurons are damaged, including multiple sclerosis (MS), a common reactive astrocytosis is present. Sedimentation field-flow fractionation (SdFFF) was used to sort astrocyte subpopulations. After SdFFF elution, cells, prepared from rat newborn cortex, were cultured and analyzed by immunocytofluorescence for glial fibrillary acidic protein (GFAP) and α-smooth muscle (SM) actin (a specific marker for myofibroblasts) expression. Cell contractile capacity was studied. Samples from patients with MS were also analyzed. Three main fractions (F1, F2, and F3) were isolated and compared with the total eluted population (TP). TP, F1, F2, and F3, contained respectively 74, 96, 12, and 98% of GFAP expressing astrocytes. In F3, astrocytes only expressed GFAP while in F1, astrocytes expressed both GFAP and α-SM actin. In F2 and TP, α-SM actin expression was barely detected. F3-derived cells showed higher contractile capacities compared with F1-derived cells. In one specific case of MS known as Baló's concentric MS, astrocytes expressing both GFAP and α-SM actin were detected. Using SdFFF, a population of astrocytes presenting myofibroblast properties was isolated. This subpopulation of astrocytes was also observed in a MS sample suggesting that it could be involved in lesion formation and remodeling during CNS pathologies.
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Affiliation(s)
- Nicolas Vedrenne
- EA 6309 "Myeline maintenance and peripheral neuropathies", University of Limoges, 87000, Limoges, France
| | - Vincent Sarrazy
- EA 6309 "Myeline maintenance and peripheral neuropathies", University of Limoges, 87000, Limoges, France.,Mediterranean Centre for Molecular Medicine, University of Nice Sophia Antipolis, INSERM U1065, 06000, Nice, France
| | - Laurence Richard
- EA 6309 "Myeline maintenance and peripheral neuropathies", University of Limoges, 87000, Limoges, France.,Department of Neurology, University Hospital of Limoges, 87000, Limoges, France
| | - Nelly Bordeau
- EA 6309 "Myeline maintenance and peripheral neuropathies", University of Limoges, 87000, Limoges, France
| | - Serge Battu
- EA 3842 "Cellular homeostasis and pathologies", University of Limoges, 87000, Limoges, France
| | - Fabrice Billet
- EA 6309 "Myeline maintenance and peripheral neuropathies", University of Limoges, 87000, Limoges, France
| | - Alexis Desmoulière
- EA 6309 "Myeline maintenance and peripheral neuropathies", University of Limoges, 87000, Limoges, France. .,Department of Physiology, Faculty of Pharmacy, University of Limoges, 2 rue du Dr. Marcland, 87025, Limoges Cedex, France.
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Kurdi M, Ramsay D. Balo's concentric lesions with concurrent features of Schilder's disease in relapsing multiple sclerosis: neuropathological findings. AUTOPSY AND CASE REPORTS 2017; 6:21-26. [PMID: 28210570 PMCID: PMC5304558 DOI: 10.4322/acr.2016.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 11/28/2016] [Indexed: 12/31/2022] Open
Abstract
Atypical inflammatory demyelinating syndromes are rare neurological diseases that differ from multiple sclerosis (MS), owing to unusual clinicoradiological and pathological findings, and poor responses to treatment. The distinction between them and the criteria for their diagnoses are poorly defined due to the lack of advanced research studies. Balo's concentric sclerosis (BCS) and Schilder's disease (SD) are two of these syndromes and can present as monophasic or in association with chronic MS. Both variants are difficult to distinguish when they present in acute stages. We describe an autopsy case of middle-aged female with a chronic history of MS newly relapsed with atypical demyelinating lesions, which showed concurrent features of BCS and SD. We also describe the neuropathological findings, and discuss the overlapping features between these two variants.
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Affiliation(s)
- Maher Kurdi
- Department of Pathology - Schulich School of Medicine & Dentistry - Western University - London/ON - Canada.; Department of Pathology - Montreal Neurological Institute - McGill University - Montreal/QC - Canada
| | - David Ramsay
- Department of Pathology - Schulich School of Medicine & Dentistry - Western University - London/ON - Canada
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