A case of Baló concentric sclerosis: a fulminant variant of multiple sclerosis?

Abstract

Modern research into Baló concentric sclerosis has revealed a characteristic neuroradiological picture, while clinical manifestations range widely, including benign and malignant forms of demyelinating disease. Immunological diagnostics remain poorly characterised. We report a 17-year-old Caucasian male from Kazakhstan who initially presented to the emergency department with acute focal neurological deficits, including right-sided hemiparesis and gait unsteadiness, mimicking acute ischaemic stroke. Brain magnetic resonance imaging revealed multifocal lesions in the thalamus, temporal, and parietal lobes with pronounced diffusion restriction, confirming Baló concentric sclerosis. Following high-dose intravenous methylprednisolone, rapid neurological improvement was observed. A subsequent relapse led to the diagnosis of relapsing-remitting multiple sclerosis, and disease-modifying therapy with ocrelizumab was initiated with a satisfactory response. This case demonstrates that Pattern I demyelination can underlie atypical variants evolving into classical multiple sclerosis, highlighting the need to combine neuroimaging with immunopathological profiling to predict disease trajectories. Keywords: Baló concentric sclerosis; multiple sclerosis; concentric ring lesions; demyelinating disease; ocrelizumab; corticosteroid treatment; case report