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A Rare Case of Balo's Concentric Sclerosis with Diverse Response to Corticosteroid Therapy.
Balo’s concentric sclerosis (BCS) is considered a rare acute
demyelinating disease of the central nervous system, of unknown etiology.
The pathophysiology and existence of this entity is controversial.
Some consider it as a discrete disorder and some consider it to be a variant of MS.
It is more common in young males. Balo's Concentric Sclerosis is classically
considered to have a rapid progression, poor outcome, and poor response to treatment.
Objectives:
The present report is a rare case of Balo’s Concentric Sclerosis which showed different
response to steroid therapy in comparison with common multiple sclerosis flare ups in the same patient before and after the course of the Balo’s.
Methods: Case report
Results:
This is a report of a 35 year old African American man presented with acute onset of numbness and clumsiness on his right hand and his face . On exam he had right central facial palsy, slow right rapid alternative movements and a broad-based gait with a subtle right circumduction. Patient underwent many investigations including brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) evaluation which confirmed the diagnosis of Multiple Sclerosis. Patient responded well to intravenous steroids. During the next 3 years, patient had multiple flare ups, all responded well to corticosteroids. Later he had another clinical relapse and this time his MRI findings were consistent with BCS. Interestingly the patient didn’t respond to multiple courses of corticosteroids, so a trial of plasmaphresis was started. The patient responded well, got better clinically and the MRI feathers of Balo’s disappeared. The patient had MS flare ups since then, which all were treated with corticosteroids with optimal response.
Conclusions:
Balo’s concentric sclerosis is a rare disease which can be considered as a variant of MS or a discrete disorder which may or may not respond to the conventional corticosteroid therapy. In depth assessment and more neuroimmunologic studies are warranted for better understanding of BCS with such unique features.