Case Report: Beyond the monophasic myth: relapsing Baló's concentric sclerosis with residual disability

Baló's concentric sclerosis (BCS) is a rare demyelinating disorder with a striking radiological signature. Its potential for relapse and the impact of vascular comorbidities on disease course remains underrecognized.

A 52-year-old woman presented with acute limb weakness and sensory disturbances. MRI revealed pathognomonic concentric rings with concentric ring-like enhancement. Despite initial remarkable response to high-dose corticosteroids, she experienced a relapse at 10 months with new-onset limb tremor, persistent blood pressure fluctuations (on the basis of partial recovery) and lesion evolution on MRI. Repeat steroid therapy achieved disease stabilization, but residual motor disability persisted with a 1-year total follow-up (6 months of stable condition after relapse).

This case highlights BCS's relapsing potential and the synergistic effect of uncontrolled hypertension on disease progression, challenging the notion of its uniformly monophasic course. Vigilant monitoring of vascular risk factors and personalized rehabilitation strategies are crucial, even after excellent initial recovery.