Vollmer b, nair kv, sillau sh, corboy j, vollmer t, alvarez e. Multiple sclerosis cns demyelinating disease 350,000 affected in us 8,50010,000 new cases yearly women. Balo concentric sclerosis is now believed to be a variant of pattern iii multiple sclerosis and probably due to metabolic problems. Ldn research trust conditions where ldn could be of. We report a patient with a spaceoccupying lesion in the parietal lobe, which presented a serious diagnostic dilemma, between a rare tumefactive demyelinating disease, such as balo concentric sclerosis and a glioma. Balos concentric sclerosis is immunologically distinct from multiple. Atypical inflammatory demyelinating syndromes of the cns. To compare the cerebrospinal fluid csf features of bcs to those of ms. Jan 18, 2018 balos concentric sclerosis bcs is a rare demyelinating disorder of the central nervous system cns characterised by concentric layers of demyelination as detected by mri or histopathology, and named after the hungarian pathologist jozsef balo 18951979 1, 2. Balos concentric sclerosis is a histological variant of ms which used to be regarded as a distinct form of the disease. The generally accepted pathologic criteria of a demyelinating disease are 1 destruction of the myelin sheaths of nerve fibers with relative sparing of the other elements of nervous tissue, i. Balo concentric sclerosis in children a case series article pdf available in journal of child neurology 295 january 2014 with 233 reads how we measure reads. Balos concentric sclerosis is often regarded as a rare variant of multiple sclerosis.
We report a case of balos concentric sclerosis diagnosed in vivo by characteristic mri changes and stereotactic biopsy. It is unclear whether bcs is a variant of multiple sclerosis ms or a disease entity in its own right. Balo concentric sclerosis is one of the borderline forms of multiple sclerosis. Citescore values are based on citation counts in a given year e. Balotitleabstract or balostitle abstract or balostitleabstract or concentric sclerosis titleabstract. This page was last edited on 7 september 2018, at 23.
Tumefactive multiple sclerosis genetic and rare diseases. Neuromyelitis optica is more strongly associated with other autoimmune diseases than ms. Balotitlearticle or balostitlearticle or balostitlearticle or concentric sclerosistitlearticle. In this case, we found that ct demonstrated only lowdensity lesions, but not their concentric pattern. Balos concentric sclerosis with extensive mri brain lesions in a 55 year old male with minimal symptoms mahmoud abdelrazek, haris kamal, karanbir singh, salman farooq, ping li suny at buffalo buffalo, ny, usa 15. Balos concentric sclerosis involving bilateral thalami. Balos disease also known as balos concentric sclerosis bcs is a rare demyelinating disorder which is characterized pathologically and. Balo diseasebalo concentric sclerosis bechets syndrome bergers disease bickerstaffs. The alternative names for balo disease, concentric sclerosis or balo concentric sclerosis, refer to the fact that balo disease is characterized by bands of intact myelin the sheath of fatty substances surrounding nerve fibers, alternating with rings of loss of myelin demyelination, in various parts of the brain and brain stem. Defining the clinical course of multiple sclerosis. The pathophysiology and existence of this entity is controversial. Determining the particular type of ms is important because the current disease modifying drugs have been proven beneficial only for the relapsingremitting types of ms. Pdf balo concentric sclerosis bcs is a rare disease considered as a variant of multiple sclerosis ms with a clinical presentation similar to.
Balos concentric sclerosis request pdf researchgate. Clinically, it is very hard to distinguish balos concentric sclerosis from multiple sclerosis but mri scans show the lesions in balos to be concentric rings of intact myelin and demyelinated zones. If you have problems viewing pdf files, download the latest version of. Concentric sclerosis balo of central nervous system other specified demyelinating diseases of central nervous system. Balos concentric sclerosis presenting with benign clinical course. Balos concentric sclerosis is immunologically distinct. This is another very rare disease that resembles multiple sclerosis. Balos concentric sclerosis bcs is a rare demyelinating disorder of the central nervous system cns characterised by concentric layers of demyelination as detected by mri or histopathology, and named after the hungarian pathologist jozsef balo 18951979 1, 2. My recovery from multiple sclerosis, disability and despair, including western and chinese medicine, tai chi, qigong, diet, neurological exercise, prayer, meditation, love and miracles. Balo first described the histological features, alternating bands of loss and partially preserved myelin, of this clinical enitity, balos concentric scleriosis bcs. Acute multiple sclerosis marburg disease and tumefactive multiple sclerosis diffuse cerebral sclerosis schilder disease and concentric sclerosis of balo neuromyelitis optica devic disease, nmo and progressive necrotic myelopathy. Multiple sclerosis cns demyelinating disease 350,000 affected in us 8,50010,000 new cases yearly. Roho cushion medicare requirements a combination skin protection and positioning seat cushion e2607, e2608, e2624, e2625 is covered for a beneficiary who meets.
In multiple sclerosis ms, damage to the myelin coating around the nerve fibers in the central nervous system cns and to the nerve fibers themselves interferes with the transmission of nerve signals between the brain, spinal cord and the rest of the body. Balos concentric sclerosis followed by mri and positron emission. Ldn research trust conditions where ldn could be of benefit 20. Pdf balo concentric sclerosis in children a case series. Balos concentric sclerosis with acute presentation and coexisting. Acute disseminated encephalomyelitis acute hemorrhagic leukoencephalitis addisons disease agammaglobulinemia alopecia areata amyotrophic lateral sclerosis ankylosing spondylitis antigbmtbm nephritis. Balo concentric sclerosis is a demyelinating disease similar to standard multiple sclerosis, but with the. Multiple sclerosis association of america genetic and rare. Disrupted nerve signals cause the symptoms of ms, which vary from one person to another. Jan 18, 2018 relevant publications were identified using the following search expression. Pitfalls in the diagnosis of a tumefactive demyelinating. In the past, the diagnosis was usually made post mortem. Bcs is often regarded as a rare variant of multiple sclerosis ms.
Further publicationscases were identified by screening the reference lists of all pubmedretrieved publications and from the authors own files. Balos concentric sclerosis associated with primary human. Balo disease balo concentric sclerosis bechets syndrome bergers disease bickerstaffs encephalitis blau syndrome bullous pemphigoid castlemans disease celiac disease chronic fatigue syndrome cfs chronic inflammatory demyelinating polyneuropathy chronic recurrent multifocal osteomyelitis chrons disease cd ibd churgstrauss syndrome. Balos concentric sclerosis was first described by marburg in 1906, but became more widely known when, in 1928, the hungarian neuropathologist josef balo published a report of a student with right hemiparesis followed by optic neuritis, who at autopsy had demyelinated lesions described as encephalitis periaxialis concentrica. Pdf balos disease also known as balos concentric sclerosis bcs is a rare demyelinating disorder which is characterized pathologically and. Balos concentric sclerosis bcs is a rare demyelinating disease of unknown aetiology characterised by large white matter lesions with concentric alternating. Balos concentric sclerosis bcs is a rare monophasic demyelinating disease known as multiple sclerosis subtype and seen as a round lesion. Case report derrick robertson, eugeniu muntean, yazan suradi, lingling rong university of south florida college of medicine, tampa, fl 33612 35th annual meeting of the american society of neuroimaging 2012 3. Histopathologic investigation was also performed in one case. All structured data from the file and property namespaces is available under the creative commons cc0 license. Multiple sclerosis association of america genetic and. Although adem is not a real ms varying form, it is strictly connected to its description both because it can mimic ms and also because final evolution to typical ms is registered in 29% of. Demyelinating disorders like multiple sclerosis ms is a common cause of neurological morbidity and mortality among the general population. Roho cushion medicare requirements jayhawk pharmacy.
Balo concentric sclerosis is considered a rare acute demyelinating disease of the central nervous system, of unknown etiology. Balos concentric sclerosis an overview sciencedirect topics. However, mri showed a striking feature, reminiscent of histopathology of balos concentric sclerosis, and played an important role in antemortem diagnosis of this rare demyelinating. Balo diseasebalo concentric sclerosis bechets syndrome bergers disease bickerstaffs encephalitis blau syndrome bullous pemphigoid cancers castlemans disease celiac disease chronic fatigue syndrome cfs chronic inflammatory demyelinating polyneuropathy chronic recurrent multifocal osteomyelitis chrons disease cd ibd churgstrauss syndrome.
Rare variants of ms like balo concentric sclerosis bcs are classically considered to have a rapid progression, poor outcome, and poor response to treatment. The alternative names for balo disease, concentric sclerosis or balo concentric sclerosis, refer to the fact that balo disease is characterized by bands of intact myelin the sheath of fatty substances surrounding nerve fibers, alternating with rings of loss of myelin demyelination, in various parts of. Patients with this disorder present with acute or subacute neurological deterioration, with mri showing one or more concentrically multilayered ringlike lesions usually in the cerebral white matter. Balos concentric sclerosis, which causes concentric rings of demyelination that can be seen on an mri, is another variant type of ms that can progress rapidly. Behavioral changes revealing superficial siderosis john bertelson. Balos concentric sclerosis bcs is a rare monophasic demyelinating disease known as multiple sclerosis subtype and seen as a round lesion with variable hyper and hypodetoxification layers.
Despite some clinician advocacy for the use of gabapentin to treat neonatal irritability of presumed neurological origin, the extent of gabapentin administration to hospitalized neonates is unknown. This was previously only diagnosed at postmortem examination and was thought to be. Multiple sclerosis and other inflammatory demyelinating. Histological examination of the brain shows sharply defined concentric rings of demyelination alternating with bands of unaffected myelin, giving an onion skin appearance fig. Pdf balos concentric sclerosis in a young female patient. Balo concentric sclerosis radiology reference article. Five bcs cases were diagnosed antemortem based on their typical concentric mass patterns on mr images and based on clinical and csf findings. Historically, balos concentric sclerosis was thought fatal in all cases.
Csf analysis was not done due to recent neurosurgery, but the diagnosis of multiple sclerosis ms, and specifically of balos concentric sclerosis. Balos concentric sclerosis bcs is a rare inflammatory. Balo titleabstract or balo stitle abstract or balostitleabstract or concentric sclerosis titleabstract. This case report highlights important diagnostic clues in the differential. Balos concentric sclerosis is a rare demyelinating condition that can affect young adults. Balos concentric sclerosis an overview sciencedirect. It can be monophasic or relapsing, and is characterized by headache, severe paresis, cognitive and figure 1. Balos concentric sclerosis is a rare subtype of demyelinating disease with characteristic radiological and pathological features. Gabapentin use for hospitalized neonates pediatric neurology. A rare case of balo concentric sclerosis showing unusual. Cases of pres posterior reversible encephalopathy syndrome have also been reported in association with nmoigg positivity. Atypical inflammatory demyelinating syndromes are rare disorders that differ from multiple sclerosis owing to unusual clinical or mri findings or poor response to treatments used for multiple sclerosis.
The initial terminology for this entity was leukoencephalitis periaxialis concentrica, which is based on its early definition of a disease in the course of which the white matter of the brain is destroyed in concentric layers in a manner that leaves the axis cylinders intact. Reliable radiological technique to differentiate between intrinsic tumor and demyelination is critical to offer the proper treatment, especially if a diagnostic biopsy is not obtained prior to treatment. Roho cushion medicare requirements a combination skin protection and positioning seat cushion e2607, e2608, e2624, e2625 is covered for a beneficiary who meets the criteria for both a skin protection seat cushion and a positioning seat cushion. Balos concentric sclerosis is immunologically distinct from. These aggressive variants are more likely to present with symptoms. For language access assistance, contact the ncats public information officer. Pdf balos concentric sclerosis with acute presentation and co. Clinical and radiographic spectrum of pathologically. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Balos concentric sclerosis bcs is a rare demyelinating disease considered to be a variant of multiple sclerosis. Ms clinical forms and variantsms clinical forms and variants. Five bcs cases were diagnosed antemortem based on their typical concentric mass patterns on mr images and based on clinical and. Jan 18, 2018 balos concentric sclerosis bcs is a rare inflammatory demyelinating disorder of the central nervous system characterised by concentric layers of demyelination. Tumefactive multiple sclerosis is characterized by a tumorlike lesion larger than two centimeters and signs and symptoms similar to those of a brain tumor.
Files are available under licenses specified on their description page. Balos concentric sclerosis in a patient with spontaneous remission. Some consider it as a discrete disorder and some consider it to be a variant of ms. Balos concentric sclerosis presenting as a ringenhancing lesion in a hivinfected patient. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis lucchinetti et al. Balo disease balo concentric sclerosis bechets syndrome bergers disease bickerstaffs encephalitis blau syndrome bullous pemphigoid cancers castlemans disease celiac disease chronic fatigue syndrome cfs chronic inflammatory demyelinating polyneuropathy chronic recurrent multifocal osteomyelitis chrons disease cd ibd churgstrauss syndrome. We aimed to identify trends in gabapentin utilization among infants hospitalized in neonatal intensive care units nicus across the united states and to evaluate the associations between clinical. Balos concentric sclerosis with acute presentation and co. Tissue preconditioning may explain concentric lesions in balo. Balos concentric sclerosis presenting with benign clinical course and multiple sclerosislike lesions on magnetic resonance images. Mri has shown that the natural history of the disease varies but with acute treatment recovery from symptomatic lesions is possible. Association between pathological and mri findings in multiple sclerosis. If you have problems viewing pdf files, download the latest version of adobe reader. Balos disease also known as balos concentric sclerosis bcs is a rare demyelinating disorder which is characterized pathologically and radiologically by concentric rings of demyelinated and relatively myelinpreserved white matter.
Balo concentric sclerosis is a demyelinating disease similar to standard multiple sclerosis, but with the particularity that the demyelinated tissues form concentric layers. These syndromes include neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis, tumefactive demyelination, balos concentric sclerosis, schilders disease, and marburgs. We describe the case of a 25yearold female presenting with strokelike symptoms who was diagnosed with bcs on mri. Determining the particular type of ms is important because the current disease modifying drugs have been proven beneficial only for. Recent multiple sclerosis and related disorders articles.
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