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

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.

A Rare Case of Balo Concentric Sclerosis, a Subtype of Tumefactive Multiple Sclerosis, in a 40-Year-Old Male: Case Report

“…This gives it the characteristic onion-like vasogenic edematous ring(s) with a halo-like appearance most commonly located in the brain's white matter. These findings are very similar in appearance to the ring-enhancing lesions seen in toxoplasmosis [ 5 , 8 ]. Unlike MS, CSF in patients with BCS has a lower frequency of oligoclonal bands, making the diagnosis harder to achieve solely based on CSF analysis.…”

“…Due to the rarity, challenging variation in presentations, and availability of technology to achieve the diagnosis of BCS, accurate incidence rates have not been accurately documented. BCS occurrence is higher in males than females, with a wide range of presenting ages from 4 to 56 years old, with an average age of 36 years old [ 1 , 5 ]. In this case report, we describe the atypical clinical presentation of a 40-year-old male diagnosed with BCS and discuss the uncertainty surrounding the definitive diagnosis and treatment of this condition.…”

Baló Concentric Sclerosis Mimicking Encephalitis with Seizures and Progressive Aphasia in a 26-Year-Old Woman: A Challenging Diagnostic Dilemma

“…In Balo's, cognitive deficits may arise from the disruption of neural circuits within the concentric lesions, while pseudo-tumoral MS-induced cognitive impairment may result from a combination of direct tissue compression, inflammation, and secondary effects on surrounding brain regions. The distinguishing radiological and pathological features of these conditions highlight the importance of accurate diagnosis for appropriate clinical management and treatment strategies [6][7][8][12][13][14][15]. The differential between Balós aphasia with other types of aphasia, like vascular aphasia with typically a sudden onset, and tumoral aphasia which tends to develop gradually and progress over time, is made by characteristic unique concentric ring lesion pattern in the brain and occurs in the context of this rare demyelinating disorder [10,[16][17][18].…”

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

“…Due to the rarity, challenging variation in presentations, and availability of technology to achieve the diagnosis of BCS, accurate incidence rates have not been accurately documented. BCS occurrence is higher in males than females, with a wide range of presenting ages from 4 to 56 years old, with an average age of 36 years old 4,5 . Patients with BCS usually present with cognitive dysfunction, headache, paralysis, and muscle spasm 6…”

“…BCS occurrence is higher in males than females, with a wide range of presenting ages from 4 to 56 years old, with an average age of 36 years old. 4,5 Patients with…”