A previously healthy 40-year-old man developed acute left-sided weakness and numbness that progressed over 2 weeks. Physical examination revealed decreased sensation to pinprick in the left arm and leg and left leg weakness. MRI supported a diagnosis of Baló concentric sclerosis (BCS), a rare demyelinating disease (figure). The concentric bands of differing intensities on MRI are due to alternating layers of normal and demyelinated tissue that is classically observed with BCS.1,2 Patients with BCS commonly present with acute neurologic symptoms, which can be due to a solitary lesion. The clinical course can be fulminant and progressive or benign. In the case presented, the patient's symptoms improved within 1 week of starting high-dose glucocorticoids.
Figure. MRI reveals multiple concentric lesions with abnormal high T2 signal and varying degrees of restricted diffusion.
The largest lesion was located in the subcortical white matter of the right parietal lobe. The lesions demonstrate concentric alternating high signals on (A) T2-weighted axial imaging that corresponded with restricted diffusion on the outermost ring on (B) diffusion-weighted imaging and (C) apparent diffusion coefficient map. Postcontrast T1-weighted imaging demonstrates faint, patchy enhancement of these lesions (not shown).
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AUTHOR CONTRIBUTIONS
Joshua Bakhsheshian: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and final approval. Maya Srikanth: drafting/revising the manuscript, accepts responsibility for conduct of research and final approval. Audrey L. French: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and final approval, acquisition of data.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
REFERENCES
- 1.Karaarslan E, Altintas A, Senol U, et al. Balo's concentric sclerosis: clinical and radiologic features of five cases. AJNR Am J Neuroradiol 2001;22:1362–1367. [PMC free article] [PubMed] [Google Scholar]
- 2.Kavanagh EC, Heran MK, Fenton DM, Lapointe JS, Nugent RA, Graeb DA. Diffusion-weighted imaging findings in Balo concentric sclerosis. Br J Radiol 2006;79:e28–e31. [DOI] [PubMed] [Google Scholar]
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