Balo's concentric sclerosis: Case report and literature review

Introduction: Balo's concectric sclerosis (BCS) is a rare demyelinating disease, usually considered as a multiple sclerosis (MS) variant with an acute clinical course and fatal progression, although recently it has been reported spontaneous remissions and relapsing-remitting cases. Case report: A 20-year-old woman with history of neurological deficits and partial recovery during the previous two years was admitted to our hospital due to right hemisensory disturbances, weakness, postural and intention high-amplitude tremor, and urinary incontinence. MRI showed an extensive subcortical frontal lesion with hyperintense concentric layers in T2 sequence, coexisting with bilateral hemispheric and infratentorial classic lesions of MS. The stereotactic biopsy showed findings consistent with BCS. After intravenous steroids treatment, the patient experienced slight improvement, being discharged for further management with immunomodulators. Here we present a narrative review with systematic literature search on the topic. Conclusion: BCS is a disease with a variable clinical course, not always fatal as previously described. Despite of this, mortality is high (up to 40%), being greater in younger subjects, females, those with primary progressive pattern and in coexisting MRI lesions of BCS and MS.