Type of publication:
European Stroke Journal; May 2018; vol. 3, Supp 1
Background and Aims: A young woman presented with a ‘stroke like’ episode subsequently found to be due to a rare form of multiple sclerosis, Balo concentric sclerosis (BCS). Method: A literature search was conducted (5/ 1/2018) using the key words: ‘Balo concentric sclerosis ‘ and ‘Stroke ‘ finding only 30 PUbMed and 5 Medline references respectively. Few case reports exist of such a presentation. Results: The Hungarian neuropathologist Josef Balo published a case report in 1928 of a young man with a new hemiparesis who was found at autopsy to have lesions described as encephalitis periaxialis concerntrica. With the advent of MRI, imaging characteristically shows an onion ring or whorled appearance. Recently it has been classified to lie within the spectrum of atypical idiopathic inflammatory demyelinating disorders, and practically is considered as a form of relapsing-remitting MS. It is more common in Chinese and Filipino populations with an estimated 2:1 female predilection with on-going uncertainty as to the relative role of genetic or environmental predespositions. We describe a 33 year old lady presenting acutely with left arm heaviness, incoordination and paraesthesia. She had no vascular risk factors and no relevant past medical or family history. MRI confirmed a classical BCS ringed lesion within the white matter of the right frontal gyrus, Lumbar puncture showed raised lymphocytes and oligoclonal bands. Conclusion: Stroke-like presentations are not uncommonly found to be due to MS but rarely of the atypical BCS type. BCS shows a characteristic onion ring appearance on MRI.