Baló's disease showing benign clinical course and co-existence with multiple sclerosis-like lesions in Chinese

Abstract

Baló's concentric sclerosis (BCS) is a rare demyelinating disorder usually considered a variant of multiple sclerosis (MS). However, its pathogenesis and its correlation with MS remains unclear and controversial. This report presents seven Hans Chinese subjects diagnosed as BCS on the basis of the pathognomonic MR (magnetic resonance) findings. Upon diagnosis, all the cases displayed good responses to corticosteroids and showed an overall benign prognosis during a follow-up period of 4—13.5 years, although three relapsed later. MR findings suggest that the characteristic concentric lesions of BCS frequently (5/7) coexist with multiple sclerosis-like lesions. During follow-up, the Baló-like lesions may either dissolve over time or transform into an MS-like lesion. Moreover, the Balóand MS-like lesions occurred one after another at the onset and relapse phases of the same patient in two cases. These clinical features suggest that Baló's disease showing benign clinical course and co-existence of multiple sclerosis (MS)-like lesion is not rare among the Chinese, and strengthens the notion that BCS correlates intrinsically with MS. Multiple Sclerosis 2008; 14: 418—424. http://msj.sagepub.com

Keywords

Baló's concentric sclerosis (BCS)magnetic resonance imaging (MRI)multiple sclerosis (MS)

Get full access to this article

View all access options for this article.

References

Kim MO , Lee SA , Choi CG , Huh JR , Lee MC Baló's concentric sclerosis: a clinical case study of brain MRI, biopsy, and proton magnetic resonance spectroscopic findings. J Neurol Neurosurg Psychiatry 1997; 62(6): 655-8.

Caracciolo JT , Murtagh RD , Rojiani AM , Murtagh FR Pathognomonic MR imaging findings in Baló concentric sclerosis. Am J Neuroradiol 2001 ; 22: 292-3

Gharagozloo AM , Poe LB , Collins GH Antemortem diagnosis of the Baló concentric sclerosis: correlative MR imaging and pathologic features . Radiology 1994; 191: 817-9.

Moore GR , Neumann PE , Suzuki K. , Lijtmaer HN , Traugott U. , Raine CS Baló's concentric sclerosis: new observation on lesion development . Ann Neurol 1985; 17(5): 604-11.

Bolay H. , Karabudak K. , Tacal T. , Onol B. , Selekler K. , Saribas O. Baló's concentric sclerosis: report of two patients with magnetic resonance imaging follow-up. J Neuroimaging 1996; 6(2): 98-103.

Karaarslan E. , Altintas A. , Senol U. , Yeni N. , Dincer A. , Bayindir C. et al. Baló's concentric sclerosis: clinical and radiological features of five cases. Am J Neuroradiol 2001; 22: 1362-7.

Rao M. -L, Liu D. -S, Lin S. -H, Liang M. , Shi X. -E. Clinical and pathological studies on ten cases of Baló's concentric sclerosis . Chin J Neurol Psychiatry 1983; 16: 299-302.

Chen C-J. Serial proton magnetic resonance spectroscopy in lesions of Baló's concentric sclerosis. J Comput Assist Tomogr 2001; 25(5): 713-8.

Hao Y. and Luo Z. The clinical features and antemortem diagnosis of Baló's disease (a report of 2 cases). Clin Med China 2003; 19(5): 415-6.

10.

Yao D. -L, Webster HD , Hudson LD , Brenner M. , Liu DS , Escobar AI et al. Concentric sclerosis (Baló): morphometric and in situ hybridization study of lesions in six patients. Ann Neurol 1994; 35: 18-30.

11.

Stadelmann C. , Ludwin S. , Tabira T. , Guseo A. , Lucchinetti CF , Leel-Ossy L. et al. Tissue preconditioning may explain concentric lesions in Baló's type of MS. Brain 2005; 128: 979-87.