title: Baló's concentric sclerosis and tumefactive demyelination: a shared immunopathogenesis?
abstract: Baló's concentric sclerosis (BCS) and tumefactive demyelination (TD) are considered atypical forms of multiple sclerosis (MS). Baló lesions are characterized by concentric rings corresponding to alternating bands of demyelination and relatively preserved myelin (Hu and Lucchinetti, 2009). Tumefactive lesions are pseudotumoural demyelinating lesions of >2 cm and may have an open ring-enhancing magnetic resonance imaging appearance (Hu and Lucchinetti, 2009; Lucchinetti et al., 2008; Altintas et al., 2012). We present a patient who developed limb weakness and focal seizures secondary to a lesion radiologically and histopathologically consistent with BCS who, six months later, developed a tumefactive demyelinating lesion. This is the first description of BCS and TD occurring in the same patient and is particularly notable because of the lack of any other more typical demyelinating lesions on the MRIs. The nature of BCS and TD in relation to more typical multiple sclerosis is discussed.
authors.affiliation: MS Australia Clinic, Brain & Mind Research Institute, University of Sydney, NSW, Australia; Neuroimmunology Clinic, Concord Repatriation General Hospital, Sydney, NSW, Australia. Electronic address: thardy@med.usyd.edu.au.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hardy
authors.affiliation: MS Australia Clinic, Brain & Mind Research Institute, University of Sydney, NSW, Australia.
authors.forename: Heidi N
authors.initials: HN
authors.lastname: Beadnall
authors.affiliation: Department of Neurology, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Sutton
authors.affiliation: Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Armin
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Brain & Mind Research Institute, University of Sydney, NSW, Australia.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Jonker
authors.affiliation: Brain & Mind Research Institute, University of Sydney, NSW, Australia; Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Buckland
authors.affiliation: MS Australia Clinic, Brain & Mind Research Institute, University of Sydney, NSW, Australia; Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Brain & Mind Research Institute, University of Sydney, NSW, Australia.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Barnett
mesh_terms: D000328:Adult; D002549:Diffuse Cerebral Sclerosis of Schilder / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans
keywords: Atypical; Multiple sclerosis; Neuroinflammation; Pseudotumour; Tumour-like