Balo concentric sclerosis Review article
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Published:
Mar 31, 2022
Keywords:
concentric sclerosis Balo’s, demyelination, multiple sclerosis
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Abstract
Concentric sclerosis Balo’s is a rare demyelinating disease of the central nervous system. Changes first described by Marburg in 1906 as acute multiple sclerosis, and then in 1928 by Balo were initially considered to be characteristic of monophasic, severe multiple sclerosis. The diagnosis was then based on histopathological examinations. Currently, thanks to the development of neuroimaging techniques, magnetic resonance imaging is the basic diagnostic method of BCS. Reports of cases with mild or self-limiting course can be found more and more often in the literature, and the changes typical of Balo are found accidentally during the differential diagnosis of demyelinating diseases. Concentric sclerosis is still described as a variant of multiple sclerosis, although some patients do not develop multiple sclerosis and many cases could be described as isolated symptom complex.
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References
1. Yao DL, Webster HF, Hudson LD et al. Concentric sclerosis (Balo): morphometric and in situ hybridization study of lesions in six patients. Ann Neurol. 1994; 35: 18-30.
2. Gu J, Wang R, Lin J et al. Concentric sclerosis: Imaging diagnosis and clinical analysis of 3 cases. Neurol India. 2003; 51: 528-30.
3. Pietroboni AM, Arighi A, De Riz MA et al. Balò’s concentric sclerosis: still to be considered as a variant of multiple sclerosis? Neurol Sci. 2015; 36(12): 2277-80. http://doi.org/10.1007/s10072-015-2297-8.
4. Miller D, Weinshenker B, Filippi M et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler J. 2008; 14(9): 1157-74. http://doi.org/10.1177/1352458508096878.
5. Wallner-Blazek M, Rovira A, Fillipp M et al. Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis. J Neurol. 2013; 260(8): 2016-22. http://doi.org/10.1007/s00415-013-6918-y.
6. Murakami Y, Matsuishi T, Shimizu T et al. Balo’s concentric sclerosis in a 4-year-old Japanese infant. Brain Dev. 1998; 20: 250-2.
7. Jarius S, Würthwein C, Behrens JR et al. Baló’s concentric sclerosis is immunologically distinct from multiple sclerosis: results from retrospective analysis of almost 150 lumbar punctures. J Neuroinflamm. 2018; 15: 22. https://doi.org/10.1186/s12974-017-1043-y.
8. Wang C, Zhang KN, Wu XM et al. Balo’s disease showing benign clinical course and co-existence with multiple sclerosis-like lesions in Chinese. Mult Scler. 2008; 14: 418-24.
9. Ertuğrul Ö, Çiçekçi E, Tuncer MC et al. Balo’s concentric sclerosis in a patient with spontaneous remission based on magnetic resonance imaging: A case report and review of literature. World J Clin Cases. 2018; 6(11): 447-54. http://doi.org/10.12998/wjcc.v6.i11.447.
10. Purohit B, Ganewatte E, Schreiner B et al. Balo’s Concentric Sclerosis with Acute Presentation and Co-Existing Multiple Sclerosis-Typical Lesions on MRI. Case Rep Neurol. 2015; 7(1): 44-50. http://doi.org/10.1159/000380813.
11. Hardy TA, Miller DH. Baló’s concentric sclerosis. Lancet Neurol. 2014; 13(7): 740-6. http://doi.org/10.1016/S1474-4422(14)70052-3.
12. Mowry EM, Woo JH, Ances BM. Baló’s concentric sclerosis presenting as a stroke-like syndrome. Nat Clin Pract Neurol. 2007; 3(6): 349-54. http://doi.org/10.1038/ncpneuro0522.
13. Tzanetakos D, Vakrakou AG, Tzartos JS et al. Heterogeneity of Baló’s concentric sclerosis: a study of eight cases with different therapeutic concepts. BMC Neurol. 2020; 20(1): 400. http://doi.org/10.1186/s12883-020-01971-2.
14. Bolay H, Karabudak R, Tacal T et al. Balo’s concentric sclerosis: report of two patients with magnetic resonance imaging follow-up. J Neuroimag. 1996; 6: 98-103.
15. Gharagozloo AM, Poe LB, Collins GH. Antemortem diagnosis of Baló concentric sclerosis: correlative MR imaging and pathologic features. Radiology. 1994; 191(3): 817-9. http://doi.org/10.1148/radiology.191.3.8184071.
16. Korte JH, Bom EP, Vos LD et al. Baló concentric sclerosis: MR diagnosis. AJNR Am J Neuroradiol. 1994; 15(7): 1284-5.
17. Kreft KL, Mellema SJ, Hintzen RQ. Spinal cord involvement in Balo’s concentric sclerosis. J Neurol Sci. 2009; 279(1-2): 114-7. http://doi.org/10.1016/j.jns.2008.12.030.
18.Jolliffe EA, Guo Y, Hardy TA et al. Clinical and Radiologic Features, Pathology, and Treatment of Baló Concentric Sclerosis. Neurology. 2021; 97(4): e414-e422. http://doi.org/10.1212/WNL.0000000000012230.
19. Moore GR, Neumann PE, Suzuki K et al. Balo’s concentric sclerosis: new observations on lesion development. Ann Neurol. 1985; 17(6): 604-11. http://doi.org/10.1002/ana.410170614.
20. Kim MO, Lee SA, Choi CG et al. Balo’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. http://doi.org/10.1136/jnnp.62.6.655.
21. Darke M, Bahador FM, Miller DC et al. Baló’s concentric sclerosis: imaging findings and pathological correlation. J Radiol Case Rep. 2013; 7(6): 1-8. http://doi.org/10.3941/jrcr.v7i6.1251.
22. Martinez HR, Rodriguez-Gonzalez IC, Escamilla-Garza JM et al. Balo’s Concentric Sclerosis with monophasic course: A report of 2 cases. Ann Med Surg (Lond). 2021; 68: 102602. http://doi.org/10.1016/j.amsu.2021.102602.
23. Chen CJ. Serial proton magnetic resonance spectroscopy in lesions of Balò concentric sclerosis. J Comput Assist Tomogr. 2001; 25(5): 713-8. http://doi.org/10.1097/00004728-200109000-00008.
24. Yeo CJJ, Hutton GJ, Fung SH. Advanced neuroimaging in Balo’s concentric sclerosis: MRI, MRS, DTI, and ASL perfusion imaging over 1 year. Radiology case reports. 2018; 13(5): 1030-5. http://doi.org/10.1016/j.radcr.2018.04.010.
25. Brown JW, Coles AJ, Jones JL. First use of alemtuzumab in Balo’s concentric sclerosis: a case report. Mult Scler. 2013; 19(12): 1673-5. http://doi.org/10.1177/1352458513498129.
26. Xie JS, Jeeva-Patel T, Margolin E. Baló’s concentric sclerosis – A rare entity within the spectrum of demyelinating diseases. J Neurol Sci. 2021; 428: 117570. http://doi.org/10.1016/j.jns.2021.117570.
27. Chitnis T, Hollmann TJ. CADASIL mutation and Balo concentric sclerosis: a link between demyelination and ischemia? Neurology. 2012; 78(3): 221-3. http://doi.org/10.1212/WNL.0b013e31823fcd3c.
2. Gu J, Wang R, Lin J et al. Concentric sclerosis: Imaging diagnosis and clinical analysis of 3 cases. Neurol India. 2003; 51: 528-30.
3. Pietroboni AM, Arighi A, De Riz MA et al. Balò’s concentric sclerosis: still to be considered as a variant of multiple sclerosis? Neurol Sci. 2015; 36(12): 2277-80. http://doi.org/10.1007/s10072-015-2297-8.
4. Miller D, Weinshenker B, Filippi M et al. Differential diagnosis of suspected multiple sclerosis: a consensus approach. Mult Scler J. 2008; 14(9): 1157-74. http://doi.org/10.1177/1352458508096878.
5. Wallner-Blazek M, Rovira A, Fillipp M et al. Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis. J Neurol. 2013; 260(8): 2016-22. http://doi.org/10.1007/s00415-013-6918-y.
6. Murakami Y, Matsuishi T, Shimizu T et al. Balo’s concentric sclerosis in a 4-year-old Japanese infant. Brain Dev. 1998; 20: 250-2.
7. Jarius S, Würthwein C, Behrens JR et al. Baló’s concentric sclerosis is immunologically distinct from multiple sclerosis: results from retrospective analysis of almost 150 lumbar punctures. J Neuroinflamm. 2018; 15: 22. https://doi.org/10.1186/s12974-017-1043-y.
8. Wang C, Zhang KN, Wu XM et al. Balo’s disease showing benign clinical course and co-existence with multiple sclerosis-like lesions in Chinese. Mult Scler. 2008; 14: 418-24.
9. Ertuğrul Ö, Çiçekçi E, Tuncer MC et al. Balo’s concentric sclerosis in a patient with spontaneous remission based on magnetic resonance imaging: A case report and review of literature. World J Clin Cases. 2018; 6(11): 447-54. http://doi.org/10.12998/wjcc.v6.i11.447.
10. Purohit B, Ganewatte E, Schreiner B et al. Balo’s Concentric Sclerosis with Acute Presentation and Co-Existing Multiple Sclerosis-Typical Lesions on MRI. Case Rep Neurol. 2015; 7(1): 44-50. http://doi.org/10.1159/000380813.
11. Hardy TA, Miller DH. Baló’s concentric sclerosis. Lancet Neurol. 2014; 13(7): 740-6. http://doi.org/10.1016/S1474-4422(14)70052-3.
12. Mowry EM, Woo JH, Ances BM. Baló’s concentric sclerosis presenting as a stroke-like syndrome. Nat Clin Pract Neurol. 2007; 3(6): 349-54. http://doi.org/10.1038/ncpneuro0522.
13. Tzanetakos D, Vakrakou AG, Tzartos JS et al. Heterogeneity of Baló’s concentric sclerosis: a study of eight cases with different therapeutic concepts. BMC Neurol. 2020; 20(1): 400. http://doi.org/10.1186/s12883-020-01971-2.
14. Bolay H, Karabudak R, Tacal T et al. Balo’s concentric sclerosis: report of two patients with magnetic resonance imaging follow-up. J Neuroimag. 1996; 6: 98-103.
15. Gharagozloo AM, Poe LB, Collins GH. Antemortem diagnosis of Baló concentric sclerosis: correlative MR imaging and pathologic features. Radiology. 1994; 191(3): 817-9. http://doi.org/10.1148/radiology.191.3.8184071.
16. Korte JH, Bom EP, Vos LD et al. Baló concentric sclerosis: MR diagnosis. AJNR Am J Neuroradiol. 1994; 15(7): 1284-5.
17. Kreft KL, Mellema SJ, Hintzen RQ. Spinal cord involvement in Balo’s concentric sclerosis. J Neurol Sci. 2009; 279(1-2): 114-7. http://doi.org/10.1016/j.jns.2008.12.030.
18.Jolliffe EA, Guo Y, Hardy TA et al. Clinical and Radiologic Features, Pathology, and Treatment of Baló Concentric Sclerosis. Neurology. 2021; 97(4): e414-e422. http://doi.org/10.1212/WNL.0000000000012230.
19. Moore GR, Neumann PE, Suzuki K et al. Balo’s concentric sclerosis: new observations on lesion development. Ann Neurol. 1985; 17(6): 604-11. http://doi.org/10.1002/ana.410170614.
20. Kim MO, Lee SA, Choi CG et al. Balo’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. http://doi.org/10.1136/jnnp.62.6.655.
21. Darke M, Bahador FM, Miller DC et al. Baló’s concentric sclerosis: imaging findings and pathological correlation. J Radiol Case Rep. 2013; 7(6): 1-8. http://doi.org/10.3941/jrcr.v7i6.1251.
22. Martinez HR, Rodriguez-Gonzalez IC, Escamilla-Garza JM et al. Balo’s Concentric Sclerosis with monophasic course: A report of 2 cases. Ann Med Surg (Lond). 2021; 68: 102602. http://doi.org/10.1016/j.amsu.2021.102602.
23. Chen CJ. Serial proton magnetic resonance spectroscopy in lesions of Balò concentric sclerosis. J Comput Assist Tomogr. 2001; 25(5): 713-8. http://doi.org/10.1097/00004728-200109000-00008.
24. Yeo CJJ, Hutton GJ, Fung SH. Advanced neuroimaging in Balo’s concentric sclerosis: MRI, MRS, DTI, and ASL perfusion imaging over 1 year. Radiology case reports. 2018; 13(5): 1030-5. http://doi.org/10.1016/j.radcr.2018.04.010.
25. Brown JW, Coles AJ, Jones JL. First use of alemtuzumab in Balo’s concentric sclerosis: a case report. Mult Scler. 2013; 19(12): 1673-5. http://doi.org/10.1177/1352458513498129.
26. Xie JS, Jeeva-Patel T, Margolin E. Baló’s concentric sclerosis – A rare entity within the spectrum of demyelinating diseases. J Neurol Sci. 2021; 428: 117570. http://doi.org/10.1016/j.jns.2021.117570.
27. Chitnis T, Hollmann TJ. CADASIL mutation and Balo concentric sclerosis: a link between demyelination and ischemia? Neurology. 2012; 78(3): 221-3. http://doi.org/10.1212/WNL.0b013e31823fcd3c.