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Baló's concentric sclerosis - A rare entity within the spectrum of demyelinating diseases. J Neurol Sci 2021; 428:117570. [PMID: 34261000 DOI: 10.1016/j.jns.2021.117570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/19/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
Baló's concentric sclerosis (BCS) is a rare, inflammatory demyelinating disease of the central nervous system (CNS). Historically, BCS was thought to be uniformly fatal and diagnosis was based on postmortem findings. With advances in modern neuroimaging, BCS is currently defined by the presence of concentric layered patterns composed of alternating rings of varying intensity. They are best appreciated on gadolinium-enhanced T1-weighted sequences and predominantly occur in the supratentorial cerebral white matter with sparing of cortical U-fibers. The lamellar pattern of the lesions likely reflects bands of demyelination and relative myelin preservation with minimal axonal loss. While BCS falls within the spectrum of atypical demyelinating diseases, there is ongoing debate over whether BCS is a phenotypical variant of multiple sclerosis (MS) or a separate entity. Corticosteroids comprise first-line therapy but there is ongoing controversy regarding appropriate maintenance therapy. First-line MS disease-modifying therapies such as interferon beta-1a are appropriate for patients who fulfill diagnostic criteria for relapsing-remitting MS. Fingolimod should likely be avoided as Baló-like lesions have been reported during its administration or after withdrawal. Monoclonal antibodies such as natalizumab and rituximab are potentially effective at reducing BCS relapses, but alemtuzumab may be relatively ineffective because humoral immunity does not play a central role in BCS pathogenesis.
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Ayrignac X, Letourneau-Guillon L, Carra-Dallière C, Duquette P, Girard M, Poirier J, Lahav B, Larochelle C, Prat A. From Baló's concentric sclerosis to multiple sclerosis: a series of 6 patients. Mult Scler Relat Disord 2020; 42:102078. [PMID: 32408148 DOI: 10.1016/j.msard.2020.102078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Baló's concentric sclerosis (BCS) is a rare CNS disorder characterized by alternating bands of demyelination on MRI. One of the main issues is its relationship with multiple sclerosis (MS). OBJECTIVES To describe 6 BCS patients. To review the risk of developing MS in BCS patients. METHODS We retrospectively recorded clinical and radiological findings of 6 BCS patients and performed a review of the literature. RESULTS Six patients (5 women) with a mean age of 25 years old were included. Main symptoms were hemiparesis/hemihypoesthesia. On MRI, two patients had a single BCS lesion and four had additional MS-like lesions. Alternating bands were usually more visible on DWI. A patient had reduced central perfusion and SWI hypointensity suggestive of a central vein. Oligoclonal bands were identified in 5/6 patients. After 7 years of follow-up, all patients achieved MS criteria with mild disability (mean EDSS 1.75; 0-4). Our literature review included 65 BCS patients from 30 studies: although CSF oligoclonal bands and the presence of additional MS lesions were associated with subsequent relapses, this was not significant. DISCUSSION/CONCLUSION Our series allows a detailed MRI description in BCS and gives a new insight into BCS evolution and its strong relationship with MS.
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Affiliation(s)
- Xavier Ayrignac
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; Département de Neurologie, CRC sclérose en plaques, CHU Montpellier, INSERM, Univ Montpellier, Montpellier, France.
| | - Laurent Letourneau-Guillon
- Département de Radiologie et Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Centre Hospitalier de l'Université de Montréal (CHUM), département de radiologie, radio-oncologie et médecine nucléaire, faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Clarisse Carra-Dallière
- Département de Neurologie, CRC sclérose en plaques, CHU Montpellier, INSERM, Univ Montpellier, Montpellier, France
| | - Pierre Duquette
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Girard
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - José Poirier
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Boaz Lahav
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Catherine Larochelle
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandre Prat
- Clinique de Sclérose en plaques du Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), and department of Neurosciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Abstract
We aim to review the imaging appearance of fulminant demyelinating disorders of central nervous system that have different pathological features, clinical course, clinical features, and imaging findings different from classic multiple sclerosis. Routine magnetic resonance imaging (MRI) can help in accurate localization of the lesions, detection of associated lesions, and monitoring of these patients. Advanced MRI combined with routine MRI can aid in differentiation fulminant demyelinating lesions from simulating malignancy. Tumefactive demyelination lesions are located in supratentorial white matter mainly frontal and parietal regions with incomplete rim enhancement. Baló concentric sclerosis shows characteristic concentric onion skin appearance. Schilder disease is subacute or acute demyelinating disorders with one or more lesions commonly involving the centrum semiovale. Marburg disease is the most severe demyelinating disorder with diffuse infiltrative lesions and massive edema involving both the cerebral hemisphere and brain stem.
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Behrens JR, Wanner J, Kuchling J, Ostendorf L, Harms L, Ruprecht K, Niendorf T, Jarius S, Wildemann B, Gieß RM, Scheel M, Bellmann-Strobl J, Wuerfel J, Paul F, Sinnecker T. 7 Tesla MRI of Balo's concentric sclerosis versus multiple sclerosis lesions. Ann Clin Transl Neurol 2018; 5:900-912. [PMID: 30128315 PMCID: PMC6093849 DOI: 10.1002/acn3.572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/18/2018] [Accepted: 04/06/2018] [Indexed: 12/20/2022] Open
Abstract
Background Baló's concentric sclerosis (BCS) is a rare condition characterized by concentrically layered white matter lesions. While its pathogenesis is unknown, hypoxia‐induced tissue injury and chemotactic stimuli have been proposed as potential causes of BCS lesion formation. BCS has been suggested to be a variant of multiple sclerosis (MS). Here, we aimed to elucidate similarities and differences between BCS and MS by describing lesion morphology and localization in high‐resolution 7 Tesla (7 T) magnetic resonance imaging (MRI) scans. Methods Ten patients with Baló‐type lesions underwent 7 T MRI, and 10 relapsing remitting MS patients served as controls. The 7 T MR imaging protocol included 3D T1‐weighted (T1w) magnetization‐prepared rapid gradient echo, 2D high spatial resolution T2*‐weighted (T2*w) fast low‐angle shot and susceptibility‐weighted imaging. Results Intralesional veins were visible in the center of all but one Baló‐type lesion. Four Baló‐type lesions displayed inhomogeneous intralesional T2*w signal intensities, which are suggestive of microhemorrhages or small ectatic venules. Eight of 10 BCS patients presented with 97 additional lesions, 36 of which (37%) had a central vein. Lesions involving the cortical gray matter and the U‐fibers were not detected in BCS patients. Conclusion Our findings support the hypothesis that BCS and MS share common pathogenetic mechanisms but patients present with different lesion phenotypes.
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Affiliation(s)
- Janina R Behrens
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Julia Wanner
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Joseph Kuchling
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Lennard Ostendorf
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Lutz Harms
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Clinical and Experimental Multiple Sclerosis Research Center Charite - Universitätsmedizin Berlin Berlin Germany
| | - Klemens Ruprecht
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Clinical and Experimental Multiple Sclerosis Research Center Charite - Universitätsmedizin Berlin Berlin Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany.,Experimental and Clinical Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group Department of Neurology University of Heidelberg Heidelberg Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group Department of Neurology University of Heidelberg Heidelberg Germany
| | - René M Gieß
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Michael Scheel
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany
| | - Judith Bellmann-Strobl
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany.,Experimental and Clinical Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Jens Wuerfel
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Medical Image Analysis Center (MIAC AG) Basel Switzerland.,qbig Department of Biomedical Engineering University Basel Basel Switzerland
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Neurology Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Berlin Institute of Health Berlin Germany.,Clinical and Experimental Multiple Sclerosis Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Experimental and Clinical Research Center Charite - Universitätsmedizin Berlin Berlin Germany.,Max Delbrück Center for Molecular Medicine Berlin Germany
| | - Tim Sinnecker
- Charité - Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health NeuroCure Cluster of Excellence NeuroCure Clinical Research Center Berlin Germany.,Medical Image Analysis Center (MIAC AG) Basel Switzerland.,Department of Neurology Universitätsspital Basel Basel Switzerland
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Amini Harandi A, Esfandani A, Pakdaman H, Abbasi M, Sahraian MA. Balo’s concentric sclerosis: an update and comprehensive literature review. Rev Neurosci 2018; 29:873-882. [DOI: 10.1515/revneuro-2017-0096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/10/2018] [Indexed: 12/17/2022]
Abstract
Abstract
Balo’s concentric sclerosis (BCS) is considered a variant of multiple sclerosis characterized by concentric lamella of alternating demyelinated and partially myelinated tissues. It is a rare and a relatively acute condition. Attacks may proceed rapidly over weeks or months, typically without remission, like Marburg’s variant, resulting in death or severe disability. However, the majority of cases have a more benign, self-limiting course with spontaneous remission. Magnetic resonance imaging is a primary imaging modality in the diagnosis of BCS. Treatment with intense immunosuppression may be indicated in patients with more aggressive form. New reports reveal more evidence regarding the pathophysiology and treatment strategies.
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Affiliation(s)
- Ali Amini Harandi
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Akram Esfandani
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Hossein Pakdaman
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Mehdi Abbasi
- Brain Mapping Research Center , Shahid Beheshti University of Medical Sciences , Tehran 1333635445 , Iran
| | - Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute , Tehran University of Medical Sciences , Tehran 1136746911 , Iran
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Atypical inflammatory demyelinating lesions and atypical multiple sclerosis. Rev Neurol (Paris) 2018; 174:408-418. [PMID: 29673573 DOI: 10.1016/j.neurol.2018.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 02/06/2023]
Abstract
Atypical idiopathic inflammatory demyelinating disorders (IIDDs) of the brain have long been known to be disorders closely related to multiple sclerosis (MS), despite having distinctive clinical and radiological characteristics. Originally, they mostly corresponded to acute-onset variants of MS that classically had poor prognoses, such as Baló's concentric sclerosis, Marburg variant of MS and Schilder's disease, and their relationship with MS was based on their shared pathological findings and the co-occurrence of these variants in patients with typical MS. More recently, other atypical disorders, such as solitary sclerosis, have also been described as belonging to the MS spectrum, raising the question of their links with MS. Meanwhile, multiple MS mimics have been described and need to be considered in the differential diagnosis of MS. In addition, thorough characterization of these atypical entities, including advanced MRI and biological studies, is now warranted to further improve their management.
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Agarwal M, Ulmer JL, Klein AP, Mark LP. Why Is This Auntminnie a Diagnostic Conundrum?: A Knowledge-Based Approach to Balo's Concentric Sclerosis From Reports of 3 Cases and Pooled Data From 68 Other Patients in the Literature. Curr Probl Diagn Radiol 2018; 48:415-422. [PMID: 29428181 DOI: 10.1067/j.cpradiol.2017.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We came across 3 cases of Balo's concentric sclerosis (BCS). The first of these patients presented to an outside hospital and was transferred to our institution due to complications resulting from a biopsy. The other 2 patients, despite having a characteristic imaging appearance and despite insistence on our part on the diagnosis of BCS, underwent a surgical procedure, which could have been prevented. This led us to review the available literature on BCS. MATERIAL AND METHODS A total of 68 patients diagnosed with BCS between 1995 and 2015 were studied and the data collected for the clinical presentation and course, imaging, spinal fluid analysis, treatment, and clinical and imaging outcome. CONCLUSIONS A 25% surgery rate (biopsy or resection) was found in the study. We concluded that this relatively high surgery rate in this auntminnie nonsurgical disease is multifactorial; and includes factors like nonfamiliarity with the disease, anxiety on the part of patients and physicians, due to a sometimes rapidly deteriorating clinical picture; and resemblance of the disease with other entities such as tumor and infection. However, characteristic imaging appearance combined with acute or subacute presentation and dramatic improvement in clinical status after high-dose steroid chemotherapy; are highly suggestive of the disease, and can prevent unnecessary surgery.
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Affiliation(s)
- Mohit Agarwal
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI.
| | - John L Ulmer
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew P Klein
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
| | - Leighton P Mark
- Section of Neuroradiology, Medical College of Wisconsin, Milwaukee, WI
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Popova EV, Bryukhov VV, Boyko AN, Krotenkova MV, Konovalova OE, Sharanova SN. [Atypical multiple sclerosis - Balo's concentric sclerosis: two case-reports and a review]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:50-53. [PMID: 28617361 DOI: 10.17116/jnevro20171172250-53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article presents two clinical cases of patients diagnosed with Balo's concentric sclerosis. Distinctive features of the pathogenesis in the aspect of differential diagnosis from other forms of multiple sclerosis and possible treatment are discussed.
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Affiliation(s)
- E V Popova
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - A N Boyko
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - O E Konovalova
- Interregional Department of Multiple Sclerosis at Moscow Clinical Hospital #24, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - S N Sharanova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Baló-like lesion associated with psoriasis and chronic autoimmune thyroiditis. Acta Neurol Belg 2015; 115:793-6. [PMID: 25847070 DOI: 10.1007/s13760-015-0472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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Cai X, Xu J, Xu J, Pan D. Serial magnetic resonance imaging representation in a Baló's concentric sclerosis. J Neurol Sci 2015; 349:266-8. [PMID: 25641388 DOI: 10.1016/j.jns.2015.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 01/24/2023]
Affiliation(s)
- Xuan Cai
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Jing Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Jiao Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China
| | - Dengji Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China.
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Ripellino P, Khonsari R, Stecco A, Filippi M, Perchinunno M, Cantello R. "Clues on Balo's concentric sclerosis evolution from serial analysis of ADC values". Int J Neurosci 2015; 126:88-95. [DOI: 10.3109/00207454.2014.989524] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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Baló's concentric sclerosis and tumefactive demyelination: A shared immunopathogenesis? J Neurol Sci 2015; 348:279-81. [DOI: 10.1016/j.jns.2014.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/18/2014] [Accepted: 11/18/2014] [Indexed: 01/22/2023]
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13
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Spaander F, Vink T, Natté R, de Bruijn S. Onion-shaped white matter disease? Clin Neurol Neurosurg 2014; 126:123-5. [DOI: 10.1016/j.clineuro.2014.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 08/18/2014] [Accepted: 08/22/2014] [Indexed: 11/26/2022]
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Chen F, Liu T, Li J, Xing Z, Huang S, Wen G, Lu G. Eccentric development of Balo's concentric sclerosis: detected by magnetic resonance diffusion-weighted imaging and magnetic resonance spectroscopy. Int J Neurosci 2014; 125:433-40. [PMID: 25051427 DOI: 10.3109/00207454.2014.946563] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The concentricity of BCS has captured wide attention; the findings of the current study may provide useful information on the centrifugal pathogenesis of BCS. OBJECTIVE This study aims to evaluate the performance of MRI, DWI and MRS in elucidating the pathogenesis of Balo's lesions expanding. METHODS Six clinically diagnosed BCS cases were reviewed, and the findings obtained by MRI, DWI and MRS were analyzed. DWI data were available for six patients, with the DWI and ADC imaging locations being central and peripheral layers of the index lesion. At TE 144ms, we calculated metabolite ratios of MRS at different depths of the demyelinating lesions and compared with the lesion on the opposite normal side for two patients. RESULTS The ADC values of 18 typical concentric lesions revealed that the central lesion had the highest ADC value, followed by the internal ring, and the outermost layer had the lowest ADC value. The reduction in NAA/Cr and the increase in Cho/Cr were more evident in the central lesion than in the internal and outermost ring. CONCLUSION The findings of DWI and MRS indicate Balo's concentric rings develop gradually and centrifugally. Of course, this hypothesis remains to be proved by further experimental studies.
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Affiliation(s)
- Feng Chen
- 1Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School of Southern Medical University, Nanjing 210002, China
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15
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Abstract
Baló's concentric sclerosis is often regarded as a rare variant of multiple sclerosis. Patients with this disorder present with acute or subacute neurological deterioration, with MRI showing one or more concentrically multilayered ring-like lesions usually in the cerebral white matter. Historically, Baló's concentric sclerosis was thought fatal in all cases. However, the availability of MRI has led to a better appreciation of the variable natural history of patients presenting with radiologically evident Baló lesions and the clinical association with multiple sclerosis and, less often, with other neurological disorders. Important advances have increased understanding of the immunopathogenic mechanisms associated with the formation of Baló lesions. However, how to treat an acute lesion and when or whether to start treatment are less well understood, although for patients with Baló lesions who also fulfil standard diagnostic criteria for multiple sclerosis, our opinion is that treatment with multiple sclerosis disease-modifying therapy would seem reasonable.
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Affiliation(s)
- Todd A Hardy
- Neuroimmunology Clinic, Department of Neurology, Concord Repatriation General Hospital, University of Sydney, NSW, Australia; MS Australia Clinic, Brain and Mind Research Institute, Sydney, NSW, Australia.
| | - David H Miller
- Department of Neuroinflammation, University College London Institute of Neurology, Queen Square MS Centre, London, UK
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