- Variant of multiple sclerosis
- Large demyelinated lesions with peculiar alternating layers of preserved and destroyed myelin
- Isolated, multiple or mixed with normal MS type lesions
- Similar lesions seen in cocaine abuse, an autoimmune reaction to levamisole – common cocaine adulterant
Imaging
- Thick concentric T2 hyperintense bands corresponding to demyelination and gliosis
- Isointense bands represent normal myelin
- Onion skin, mosaic or floral configuration
- Centre of lesion shows no layering – storm centre
- Inflammatory edge of lesion shows contrast enhancement and restricted diffusion
- Predominantly in cerebral white matter
- Brain stem, cerebellum and spinal cord involvement reported
Read more
Sarbu, Nicolae, et al. “White matter diseases with radiologic-pathologic correlation.” Radiographics 36.5 (2016): 1426-1447.
Karaarslan, Ercan, et al. “Balo’s concentric sclerosis: clinical and radiologic features of five cases.” American journal of neuroradiology 22.7 (2001): 1362-1367.
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