A rare case of Balo concentric sclerosis showing unusual clinical improvement and response with oral prednisolone

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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“…MRI reveals more findings in BCS and MS than CT's. 4,7,9 MRS is very important, it is the key to help diagnose BCS, 1 just like in our case.…”

Section: Discussionmentioning

confidence: 70%

“…The term "concentric" springs from lesion morphology the same as "onion-like" in which layers of demyelinated and myelinated tissue arrange concentrically and alternately. BCS symptoms include headaches, muscle pain or spasms, weakness, paralysis, dysphasia, dysarthria, or cognitive impairment, 4,5 such as in our case.…”

Section: Discussionmentioning

confidence: 75%

Balo’s Concentric Sclerosis Mimicking Tumor on Magnetic Resonance Imaging in a Young Patient

Hoang

Trinh

Van

et al. 2021

Clin Med Insights Case Rep

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“…The inflammatory response, which was mostly made up of T lymphocytes, macrophages, and a variable amount of CD20-positive B cells, served as the backdrop for all these alterations. 12 It often manifests in young boys as specific neurological abnormalities such as hemiplegia, hemianesthesia, or coordination issues. Cerebellum, spinal cord, and optic chiasm involvement have also been documented.…”

Section: Discussionmentioning

confidence: 99%

“…Lesions that looked like Baló lesions had either a lamellar or mosaic pattern with patches of demyelinated and myelinated areas surrounding a larger demyelinated area, called the storm center, or a pattern of parallel rings with and without myelin. The inflammatory response, which was mostly made up of T lymphocytes, macrophages, and a variable amount of CD20‐positive B cells, served as the backdrop for all these alterations 12 . It often manifests in young boys as specific neurological abnormalities such as hemiplegia, hemianesthesia, or coordination issues.…”

Section: Discussionmentioning

confidence: 99%

A rare case of Balo's disease in a young adult: A clinical presentation and management

Singh,

Almusleh,

Mandru

et al. 2024

Clinical Case Reports

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Key Clinical MessageAccurate diagnosis of rare neurological conditions like Balo's concentric sclerosis (BCS) is challenging but crucial for tailored treatment. Interdisciplinary collaboration and further research are essential to advance our understanding.AbstractThis case report presents a 32‐year‐old female patient with a puzzling neurological condition characterized by feverish feelings, joint pain, unclear speech, and an unsteady gait. Initial management did not lead to improvement, and further examination revealed neurological involvement and joint tenderness without signs of inflammatory arthritis. Laboratory investigations ruled out infectious and autoimmune causes. Magnetic resonance imaging (MRI) showed well‐defined lesions with concentric rings, leading to a diagnosis of Balo' concentric sclerosis. Treatment with intravenous methylprednisolone resulted in limited improvement. This case highlights the importance of thorough evaluation and collaboration in diagnosing rare neurological conditions. Further research is needed to enhance the understanding and treatment of rare neurological disorders.

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Balo's Concentric Sclerosis in a Patient with Previous Recurrent Optic Neuritis

Kim¹,

Yoon²,

Yum³

et al. 2015

J Korean Neurol Assoc

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Balo's concentric sclerosis is regarded as a rare variant of multiple sclerosis. Traditionally, Balo's concentric sclerosis was a post-mortem diagnosis, but the recent introduction of brain magnetic resonance imaging (MRI) scans may allow noninvasive access without biopsy. Brain MRI findings of Balo's concentric sclerosis is characteristic concentric configuration of alternating bands of white matter of different pathology, with relatively preserved myelination alternating with regions of demyelination in the cerebral white matter. We report a case of Balo's concentric sclerosis with recurrent optic neuritis.

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A rare case of Balo concentric sclerosis showing unusual clinical improvement and response with oral prednisolone

Cited by 3 publications

References 5 publications

Balo’s Concentric Sclerosis Mimicking Tumor on Magnetic Resonance Imaging in a Young Patient

Balo’s Concentric Sclerosis Mimicking Tumor on Magnetic Resonance Imaging in a Young Patient

A rare case of Balo's disease in a young adult: A clinical presentation and management

Balo's Concentric Sclerosis in a Patient with Previous Recurrent Optic Neuritis

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