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Baló's concentric sclerosis and tumefactive demyelination: a shared immunopathogenesis?
Todd A Hardy1, Heidi N Beadnall2, Ian J Sutton3
1MS Australia Clinic, Brain & Mind Research Institute, University of Sydney, NSW, Australia; Neuroimmunology Clinic, Concord Repatriation General Hospital, Sydney, NSW, Australia.
Journal of the Neurological Sciences
|December 6, 2014
Summary
This case study details the first instance of Baló's concentric sclerosis (BCS) and tumefactive demyelination (TD) co-occurring in a single patient with multiple sclerosis (MS). The findings highlight the complex spectrum of demyelinating diseases.
Area of Science:
- Neurology
- Neuroimmunology
- Radiology
Background:
- Baló's concentric sclerosis (BCS) and tumefactive demyelination (TD) are rare, atypical variants of multiple sclerosis (MS).
- BCS lesions exhibit characteristic concentric rings of demyelination and preserved myelin.
- TD lesions are large (>2 cm), pseudotumoural, and may show ring enhancement on MRI.
Observation:
- A patient presented with limb weakness and seizures due to a BCS lesion.
- Six months later, the same patient developed a distinct tumefactive demyelinating lesion.
- Notably, no other typical multiple sclerosis lesions were observed on MRI.
Findings:
- This is the first documented case of a patient exhibiting both BCS and TD.
- The co-occurrence was observed without the presence of more typical demyelinating lesions.
- Radiological and histopathological findings confirmed both BCS and TD in the same individual.
Implications:
- This case expands the understanding of the phenotypic variability within demyelinating diseases.
- It suggests a potential overlap or shared pathogenic mechanisms between BCS and TD.
- Further research is warranted to explore the relationship between these atypical MS forms and typical MS.
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