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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | Balo Concentric Sclerosis | 1A0 Case 1 History
Case 1 History ---- The patient was a 39 year old man without significant past medical history. He experienced the new onset of expressive aphasia that progressed over the subsequent 2 months with a waxing and waning course. CSF showed 5 RBC, 6 WBC, protein 46, glucose 64, normal MS panel (i.e., absence of oligoclonal bands), and no evidence of malignancy. He received a 5-day course of Solu-Medrol, followed by outpatient steroid taper. The patient reported only a transient improvement after the 5-day course. Monthly magnetic resonance imaging studies showed an enhancing lesion in the left frontal white matter which began as a diffuse 1 cm sphere, but progressively expanded outward and formed concentric incomplete rings with surrounding vasogenic edema. Radiological diagnosis was Balo's concentric sclerosis. The enhancing lesion was sampled by brain biopsy using a stereotactic approach. Five years later an MRI examination showed multiple T2 FLAIR hyperintense white matter lesions in keeping with multiple sclerosis. Brain parenchymal volume was stable. His left frontal T2 FLAIR hyperintense white matter lesion was stable without the development of focal new lesions. There were no enhancing lesions.
