Baló's Concentric Sclerosis: Clinical and Radiologic Features of Five Cases
Ercan Karaarslana,
Ayse Altintasa,
Utku Senola,
Naz Yenia,
Alp Dincera,
Cicek Bayindira,
Naci Karaagaca and
Aksel Sivaa
a From the Intermed Medical Center (E.K.); the Department of Neurology, Cerrahpasa School of Medicine, Istanbul University (A.A., N.Y., N.K., A.S.); the Department of Radiology, School of Medicine, Akdeniz University (U.S.); the Radyomar Medical Center (A.D.); and the Department of Pathology, Istanbul School of Medicine, Istanbul University (C.B.), Istanbul, Turkey.
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FIG 1. Images of a 52-year-old man who developed acute left hemiparesis, ataxia, and agitation (case 1).
A, Sagittal view T1-weighted MR image (560/12/2 [TR/TE/excitations]) shows a lesion in a concentric ring pattern in the right centrum semiovale.
B, Coronal view T1-weighted MR image with contrast enhancement shows focal, peripheral enhancement in the lesion.
C, Histopathologic image shows the area that its myelin-spared ( ) and strictly separated from the demyelinated area, which contains a high number of macrophages (hematoxylin and eosin, original magnification x125). On the right (Sudan black, original magnification x500), the demyelinated area and macrophages, including black myelin debris, can be seen ( ).
D, Coronal view fluid-attenuated inversion recovery image (15000/170/1; inversion time, 2500 ms) shows a residual concentric lesion 13 months after surgery.
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FIG 2. Images of a 20-year-old woman who was admitted because of acute left hemiparesis (case 2).
A, Coronal view fluid-attenuated inversion recovery image (10000/102/1; inversion time, 1800 ms) shows the concentric lesion with two rings located in the right periventricular white matter adjacent to the corpus callosum.
B, After injection of contrast material, enhancement at the outer ring of the concentric lesion is seen on T1-weighted MR image.
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FIG 3. Images of a 48-year-old man who developed acute sensorial aphasia 4 days before admission (case 3).
A, Axial view T2-weighted MR image (5200/95/2) shows a concentric lesion and peripheral edema in the left temporoparietal white matter.
B, Axial view unenhanced T1-weighted MR image (620/18/2) shows another lesion with concentric pattern in the left centrum semiovale.
C, Coronal view fluid-attenuated inversion recovery image (15000/170/1; inversion time, 2600 ms) shows a concentric lesion in the left temporoparietal white matter and a multiple sclerosis-like lesion in the right hemisphere.
D, Coronal view fluid-attenuated inversion recovery image (15000/170/1; inversion time, 2600 ms), obtained 1 month after treatment, shows impairment of the concentric pattern and edema of the lesion located in the left temporoparietal region.
E, Coronal fluid-attenuated inversion recovery image (8000/110/2; inversion time, 2500 ms), obtained nearly 4 years after diagnosis, shows that the concentric pattern of the lesion has totally disappeared. Only small gliotic reminiscent lesions are seen.
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FIG 4. T1-weighted contrast-enhanced MR image (513/14/2) of a 38-year-old man who was admitted because of acute onset of dysarthria, dysphagia, and fatigue shows an active concentric lesion with prominent enhancement on the right side and small demyelinating lesions with peripheral enhancement in the same hemisphere (case 4)
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FIG 5. Images of a 15-year-old female patient who presented with acute left hemiparesis (case 5).
A, Axial view unenhanced T1-weighted MR image (720/18/1) shows a concentric lesion with minimal hyperintensity at its outer ring due to magnetization transfer.
B, Multivoxel spectroscopic image (1500/20/2) of the concentric lesion shows increased choline peak and decreased N-acetyl aspartate peak.
C, Spectroscopic image of normal appearing white matter near the lesion shows all peaks as normal.
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