BALO CONCENTRIC SCLEROSIS

Abstract

A clinico-pathological case of concentric sclerosis (Balo type) is reported. A 30-yr-old man experienced dizziness, nausea and vomiting. He developed gait disturbances 12 days later. Neurological examination showed broad based gait, brisk tendon reflexes, bilateral extensor plantar responses, right hemihypoesthesia, cerebellar dysmetria and a left lateral gaze palsy. CSF examination showed 520 mg/100 ml protein, 7500 red blood cells, 31 lymphocytes and 9 polymorphonuclear leukocytes/mm3, 18/100 gammaglobulin. Three CT [computed tomography] scans were performed and showed a round hypodensity in the parieto-occipital white matter with contrast enhancement on 1 occasion, and several other hypodensities in the contralateral parieto-occipital white matter and in both frontal lobes. The patient became comatose 23 days after the onset of the disease. A cerebral biopsy was obtained from 1 of the frontal lesions. He died from aspiration bronchopneumonia 2 mo. after the first signs. Neuropathological examination showed numerous concentric zones of demyelination which involved the white matter of both hemispheres, brain stem, and cerebellum. On light microscopy sudanophilic myelin breakdown products were numerous in the bands of demyelinization. Astrocytic proliferation was marked, with frequent Rosenthal fibers. Edema was noted in some lesions. Myelin-axonal dissociation was obvious, but some axonal swelling was observed. EM demonstrated the integrity of oligodendrocytes and of blood vessels and confirmed the prominent alterations of the astrocytes. The present case seems to be the 1st one with CT scan examination and EM study of a brain biopsy. The nosological situation of Balo''s disease among the inflammatory demyelinating diseases of the group of MS [multiple sclerosis] is discussed.