2011, Number 4
<< Back
Rev Mex Neuroci 2011; 12 (4)
Balo’s concentric sclerosis: Case report and literature review
Andrade-Ramos MÁ, Núñez-Velasco S, Chiquete E, Espejo PI, Riestra-Castañeda R, Vargas-Sánchez Á, Zúñiga-Ramírez C, Ruiz-Sandoval JL
Language: Spanish
References: 37
Page: 210-215
PDF size: 254.30 Kb.
ABSTRACT
Introduction: Balo’s concectric sclerosis (BCS) is a rare demyelinating disease, usually considered as a multiple sclerosis (MS) variant with an acute clinical course and fatal progression, although recently it has been reported spontaneous remissions and relapsingremitting cases.
Case report: A 20-year-old woman with history of neurological deficits and partial recovery during the previous two years was admitted to our hospital due to right hemisensory disturbances, weakness, postural and intention high-amplitude tremor, and urinary incontinence. MRI showed an extensive subcortical frontal lesion with hyperintense concentric layers in T2 sequence, coexisting with bilateral hemispheric and infratentorial classic lesions of MS. The stereotactic biopsy showed findings consistent with BCS. After intravenous steroids treatment, the patient experienced slight improvement, being discharged for further management with immunomodulators. Here we present a narrative review with systematic literature search on the topic.
Conclusion: BCS is a disease with a variable clinical course, not always fatal as previously described. Despite of this, mortality is high (up to 40%), being greater in younger subjects, females, those with primary progressive pattern and in coexisting MRI lesions of BCS and MS.
REFERENCES
Capello E, Mancardi GL. Marburg type and Baló’s concentric sclerosis: rare and acute variants of multiple sclerosis. Neurol Sci 2004; 25(Suppl. 4): S361-3.
Lindquist S, Bodammer N, Kaufmann J, König F, Heinze HJ, Brück W, et al. Histopathology and serial, multimodal magnetic resonance imaging in a multiple sclerosis variant. Mult Scler 2007; 13: 471-82.
Karaarslan E, Altintas A, Senol U, Yeni N, Dincer A, Bayindir C, et al. Balóüs concentric sclerosis: clinical and radiologic features of five cases. AJNR Am J Neuroradiol 2001; 22: 1362-7.
Stadelmann C, Brück W. Lessons from the neuropathology of atypical forms of multiple sclerosis. Neurol Sci 2004; 25(Suppl. 4: S319-22).
Moore GR, Berry K, Oger JJ, Prout AJ, Graeb DA, Nugent RA. Balóüs concentric sclerosis: surviving normal myelin in a patient with a relapsingremitting clinical course. Mult Scler 2001; 7: 375-82.
Wiendl H, Weissert R, Herrlinger U, Krapf H, Küker W. Diffusion abnormality in Baloüs concentric sclerosis: clues for the pathogenesis. Eur Neurol 2005; 53: 42-4.
Chaodong W, Zhang KN, Wu XM, Gang H, Xie XF, Qu XH, Xiong YQ. Baloüs disease showing benign clinical course and co-existence with multiple sclerosis-like lesions in Chinese. Mult Scler 2008; 14: 418-24.
Bribián A, de Castro F. Oligodendrocytes: their embryonic origin, migration and therapeutic implications. Rev Neurol 2007; 45: 535-46.
Matsuoka T, Suzuki SO, Iwaki T, Tabira T, Ordinario AT, Kira J. Aquaporin- 4 astrocytopathy in Balóüs disease. Acta Neuropathol 2010;120:651- 60.
Chen CJ. Serial proton magnetic resonance spectroscopy in lesions of Balò concentric sclerosis. J Comput Assist Tomogr 2001; 25: 713-8.
Wang L, Liu YH. Baloüs concentric sclerosis. Lancet 2010; 376: 189.
Moore GR, Neumann PE, Suzuki K, Lijtmaer HN, Traugott U, Raine CS. Baloüs concentric sclerosis: new observations on lesion development. Ann Neurol 1985; 17: 604-11.
Nandini M, Gourie-Devi M, Shankar SK, Mustare VB, Ravi V. Baloüs concentric sclerosis diagnosed intravitam on brain biopsy. Clin Neurol Neurosurg 1993; 95: 303-9.
Yao DL, Webster HD, Hudson LD, Brenner M, Liu DS, Escobar AI, et al. Concentric sclerosis (Baló): morphometric and in situ hybridization study of lesions in six patients. Ann Neurol 1994; 35: 18-30.
Gharagozloo AM, Poe LB, Collins GH. Antemortem diagnosis of Baló concentric sclerosis: correlative MR imaging and pathologic features. Radiology 1994; 191: 817-9.
Sekijima Y, Tokuda T, Hashimoto T, Koh CS, Shoji S, Yanagisawa N. Serial magnetic resonance imaging (MRI) study of a patient with Baloüs concentric sclerosis treated with immunoadsorption plasmapheresis. Mult Scler 1997;2:291-4.
Kim MO, Lee SA, Choi CG, Huh JR, Lee MC. Baloüs concentric sclerosis: a clinical case study of brain MRI, biopsy, and proton magnetic resonance spectroscopic findings. J Neurol Neurosurg Psychiatry 1997; 62: 655-8.
Murakami Y, Matsuishi T, Shimizu T, Yamashita Y, Nagamitsu S, Kojima K, et al. Balóüs concentric sclerosis in a 4-year-old Japanese infant. Brain Dev 1998; 20: 250-2.
Ng SH, Ko SF, Cheung YC, Wong HF, Wan YL. MRI features of Balo’s concentric sclerosis. Br J Radiol 1999; 72: 400-3.
Chen CJ, Chu NS, Lu CS, Sung CY. Serial magnetic resonance imaging in patients with Balóüs concentric sclerosis: natural history of lesion development. Ann Neurol 1999; 46: 651-6.
Singh S, Kuruvilla A, Alexander M, Korah IP. Baloüs concentric sclerosis: value of magnetic resonance imaging in diagnosis. Australas Radiol 1999; 43: 400-4.
Iannucci G, Mascalchi M, Salvi F, Filippi M. Vanishing Balò-like lesions in multiple sclerosis. J Neurol Neurosurg Psychiatry 2000; 69: 399- 400.
Caracciolo JT, Murtagh RD, Rojiani AM, Murtagh FR. Pathognomonic MR imaging findings in Balo concentric sclerosis. AJNR Am J Neuroradiol 2001; 22: 292-3.
Kastrup O, Stude P, Limmroth V. Baloüs concentric sclerosis. Evolution of active demyelination demonstrated by serial contrast-enhanced MRI. J Neurol 2002; 249: 811-4.
Gu J, Wang R, Lin J, Fang S. Concentric sclerosis: imaging diagnosis and clinical analysis of 3 cases. Neurol India 2003; 51: 528-30.
Stadelmann C, Ludwin S, Tabira T, Guseo A, Lucchinetti CF, Leel-Ossy L, Ordinario AT, Brück W, Lassmann H. Tissue preconditioning may explain concentric lesions in Balóüs type of multiple sclerosis. Brain 2005; 128: 979-87.
Airas L, Kurki T, Erjanti H, Marttila RJ. Successful pregnancy of a patient with Baloüs concentric sclerosis. Mult Scler 2005; 11: 346-8.
Pohl D, Rostasy K, Krone B, Hanefeld F. Balóüs concentric sclerosis associated with primary human herpesvirus 6 infection. J Neurol Neurosurg Psychiatry 2005; 76: 1723-5.
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: 28-31.
Ball T, Malik O, Roncaroli F, Quest RA, Aviv RI. Apparent diffusion coefficient changes and lesion evolution in Baloüs type demyelinationcorrelation with histopathology. Clin Radiol 2007; 62: 498-503.
Mowry EM, Woo JH, Ances BM. Balóüs concentric sclerosis presenting as a stroke-like syndrome. Nat Clin Pract Neurol 2007;3:349-54.
Khiat A, Lesage J, Boulanger Y. Quantitative MRS study of Balóüs concentric sclerosis lesions. Magn Reson Imaging 2007; 25: 1112-5.
Kishimoto R, Yabe I, Niino M, Sato K, Tsuji S, Kikuchi S, et al. Balóüs concentric sclerosislike lesion in the brainstem of a multiple sclerosis patient. J Neurol 2008; 255: 760-1.
Dreha-Kulaczewski SF, Helms G, Dechent P, Hofer S, Gärtner J, Frahm J. Serial proton MR spectroscopy and diffusion tensor imaging in infantile Baloüs concentric sclerosis. Neuroradiology 2009; 51: 113-21.
Kreft KL, Mellema SJ, Hintzen RQ. Spinal cord involvement in Baloüs concentric sclerosis. J Neurol Sci 2009; 279: 114-7.
Graber JJ, Kister I, Geyer H, Khaund M, Herbert J. Neuromyelitis optica and concentric rings of Baló in the brainstem. Arch Neurol 2009; 66: 274-5.
Li Y, Xie P, Fan X, Tang H. Balòüs concentric sclerosis presenting with benign clinical course and multiple sclerosis-like lesions on magnetic resonance images. Neurol India 2009; 57: 66-8.