Bal^|^oacute;'s Concentric Sclerosis in Multiple Sclerosis

Barbara Barun, Ivan Adamec, Mario Habek
2012 Internal medicine (Tokyo. 1992)  
A 43-year-old woman presented with right optic neuritis. Brain MRI showed multiple periventricular and juxtacortical demyelinating lesions and cerebrospinal fluid (CSF) analysis showed positive oligoclonal IgG bands. She was treated with intravenous methylprednisolone and fully recovered. A follow-up brain MRI showed one new lesion and she was diagnosed with clinically definite multiple sclerosis MS according to McDonald's criteria (1). Treatment with inter-feron beta 1a was started. In the
more » ... started. In the subsequent five years she was without new symptoms or new lesions on brain MRI. Her current problems started two days earlier with speaking difficulties. Neurological examination revealed transcortical motor aphasia. Brain MRI showed a left periventricular lesion with concentric bands of variable hyperintensity. Postcontrast sequences (Picture D) showed enhancement in alternating rings throughout the lesion. Diffusion-weighted image
doi:10.2169/internalmedicine.51.8094 pmid:22864141 fatcat:6m7hh6wbyvflday2ovdpuh6vd4