Baló concentric sclerosis

Case contributed by Wesam Shamma
Diagnosis almost certain

Presentation

Left hemiparesis, headaches and cognitive decline

Patient Data

Age: 20 years
Gender: Female
mri
This study is a stack
Axial
T2
This study is a stack
Coronal
T2
This study is a stack
Axial
FLAIR
This study is a stack
Sagittal
FLAIR
Axial
DWI
Axial
ADC
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Info

There are multiple subcortical, periventricular, pericallosal and callosal (genu and splenium) T2W/FLAIR hyperintense lesions giving (Dawson fingers) appearance, the largest seen in the right centrum semiovale showing concentric areas of alternating signal intensities with a ring of diffusion restriction measuring about 22 x 25 mm.

Patchy restricted diffusion seen in lesions of the splenium of corpus callosum.

Case Discussion

Baló concentric sclerosis is a variant of multiple sclerosis with alternating intralesional intensities giving a 'bullseye' or 'onion bulb' appearance.

The regions of true diffusion restriction reflect active demyelination. 

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