Balo's concentric sclerosis

Abstract

We report a case of Balo's concentric sclerosis with peculiar MRI findings. Unlike previously published cases all concentric rings in our case showed marked enhancement, supporting the view of synchronous active demyelination in the lesion. Follow-up MRI disclosed a change of the lesions into a confluent pattern more resembling a typical large MS plaque. There were no oligoclonal bands or intrathecal Ig-G synthesis. The hypothesis concerning the pathophysiology of the lesions' typical and peculiar morphological appearance and its relationship to multiple sclerosis are briefly discussed.

The Origins of Concentric Demyelination: Self-Organization in the Human Brain

“…An MRI follow-up study of Baló patients has shown that the demyelinated layers form progressively in a centrifugal way [5]. More recent results nevertheless indicate that the process of active demyelination takes place synchronously rather than successively, with a progressive evolution of the lesions towards homogeneous MS plaques [6]. Furthermore, MR spectroscopic studies have confirmed the analogies between Baló's sclerosis and classical MS [7].…”

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

“…[3] Brain biopsy is the gold standard, but with the advent of MRI, many more cases are now being diagnosed ante mortem. [4] Spectroscopy (H+) shows a choline peak due to demyelination as in MS.[1] Earlier it was considered as a disease with poor prognosis, but recent cases and our case show that in a single monophasic event, complete response to therapy and survival is possible. Other presentations are the primary, progressive, and relapsing remitting type.…”

Balo’s concentric sclerosis in a patient with spontaneous remission based on magnetic resonance imaging: A case report and review of literature

“…It has been stated that in the MR sections of the BCS lesions, the flow of the contras material may be in the peripheral direction. However, it was determined that the density of lesion layers increased in T2 weighted sections[ 7 , 21 ]. BCS lesions are frequently seen in the white matter layer (substantia alba) of cerebrum.…”

“…As supported in previously reported clinical trials, BCS is not always a fatal disease and supports the definition that it may be a self-limiting disease. Although BCS is usually known to possess a fulminant demyelinating course, there are cases in the literature with favorable prognoses and occasionally cases with spontaneous remission[ 21 ]. The unexpected finding of spontaneous remission without any treatment was noted in this case.…”