Balo concentric sclerosis

  • 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
  • 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
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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.