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Baló's concentric sclerosis: surviving normal myelin in a patient with a relapsing-remitting clinical course

Department of Pathology and Laboratory Medicine (Neuropathology), Vancouver Hospital and Health Services Centre, Vancouver, BC, Canada, The University of British Columbia, Vancouver, BC, Canada V5Z 1L8

K Berry

Department of Pathology and Laboratory Medicine (Neuropathology), St Paul's Hospital, Vancouver, BC, Canada, The University of British Columbia, Vancouver, BC, Canada V5Z 1L8

J JF Oger

Department of Medicine (Neurology), Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada, The University of British Columbia, Vancouver, BC, Canada V5Z 1L8

A JE Prout

Department of Medicine (Neurology), St Paul's Hospital, Vancouver, BC, Canada,The University of British Columbia, Vancouver, BC, Canada V5Z 1L8

D A Graeb

Department of Radiology (Neuroradiology), Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada, The University of British Columbia, Vancouver, BC, Canada V5Z 1L8

R A Nugent

Department of Radiology (Neuroradiology), Vancouver Hospital and Health Sciences Centre, Vancouver, BC, Canada, The University of British Columbia, Vancouver, BC, Canada V5Z 1L8

Baló's concentric sclerosis is a demyelinating disorder in which bands of demyelination alternate with concentric bands of myelin preservation. The pathogenesis of the lesion is unknown. Previous reports using modern histopathologic techniques have shown the bands of myelin preservation to be comprised of remyelinated or partially demyelinated myelin. Here we report a case of Baló's concentric sclerosis in a 24-year-old East Indian patient with a previous history of relapsing-remitting multiple sclerosis (MS). Pathologically, the bands of myelin preservation showed myelin sheaths of normal thickness, with focal areas of demyelination. The findings, taken together with those of previously reported cases, suggest that Baló's concentric sclerosis is a variant of MS, and the concentric lesion may be an intermediary form in evolution of a chronic active MS plaque. The pathogenesis of this concentric lesion may be explained by periodic suppression of demyelination in the rapidly expanding border, allowing remyelination or only transient incomplete demyelination to occur.

Key Words: multiple sclerosis • Balo's concentric sclerosis • myelin • demyelination • magnetic resonance imaging

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