Balós concentric sclerosis

摘要

A previously healthy 13-year-old boy presented with left arm and face weakness. Brain MRI (figure 1, axial Tl postcontrast) revealed an enhancing mass within the right centrum semio-vale, and a second non-enhancing lesion in the left occipital region (not shown). Lumbar puncture revealed five oligoclo-nal bands, giving a working diagnosis of a demyelinating disorder. Intravenous methylprednisolone was given, and his symptoms nearly resolved. Within days, he returned with complete left arm and leg.hemiparesis. Repeat MRI (figure 2, axial Tl postcontrast) revealed a lesion with concentric rings and peripheral enhancement. Based on his clinical picture, oligoclonal bands in the cerebrospinal fluid and characteristic imaging findings, a diagnosis of Balos concentric sclerosis was given. Balos concentric sclerosis is a rare demyelinating disease considered to be a variant of multiple sclerosis. It is an unusual entity in the paediatric population. Typical MRI changes consist of concentric rings or a whorled appearance.1 The characteristic pathological findings are alternating rings of myelin preservation or remyelination and myelin loss, consistent with demyelination, involving the cerebral hemispheres, cerebellum, brain stem, spinal cord and optic chiasm.2 Diagnosis is made via MRI and with the observance of oligoclonal bands in the cerebrospinal fluid.