title: Early diagnosis of Balo's concentric sclerosis by diffusion tensor tractography: a case report and literature review.
abstract: Balo concentric sclerosis is an infrequent variant of a demyelinating disease related to multiple sclerosis, initially thought to have an acute presentation and a fatal outcome. Recent studies have reported non-fatal forms of Balo concentric sclerosis, focusing on the importance of early diagnosis using magnetic resonance imaging (MRI), along with spectroscopy and diffusion/perfusion sequences. Recently, we have been able to draw a three-dimensional image of a specific bundle of fibers by means of a diffusion tensor technique of the magnetic resonance imaging tractography (t-MRI). We report the case of a young woman presenting with acute and progressive focal neurological symptoms, including right body paresis, whose diagnosis was suggested by MRI and confirmed by pathology to be Balo concentric sclerosis. She was treated with boluses of methylprednisolone, achieving full neurological remission one year after admission. This is, to our knowledge, the first report describing the use of t-MRI for diagnosing BCS. We consider that t-MRI will allow, in a near future, early diagnosis of the disease, its prompt treatment, and establishing new classification criteria. This case confirms the existence of benign forms of Balo concentric sclerosis with a good response to steroid therapy, where functional recovery is possible.
authors.affiliation: Departamento de Neurología, Fundación Clínica Médica Sur, México. Address: Etapa La Brisa, Manzana 5, Villa 15, Ciudad Celeste, Samborondón, Ecuador. Email: ca_penaherrera@hotmail.com.
authors.forename: Juan Alberto
authors.initials: JA
authors.lastname: Nader Kawachi
authors.affiliation: Departamento de Neurología, Fundación Clínica Médica Sur, México.
authors.forename: María de la Luz
authors.initials: Mde L
authors.lastname: Andrade Magdaleno
authors.affiliation: Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.
authors.forename: Carlos Andrés
authors.initials: CA
authors.lastname: Peñaherrera
authors.affiliation: Departamento de Resonancia Magnética, Fundación Clínica Médica Sur, México.
authors.forename: Yeni
authors.initials: Y
authors.lastname: Fernández De Lara
authors.affiliation: Departamento de Patología, Fundación Clínica Médica Sur, México.
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Lavenant Borja
mesh_terms: D000328:Adult; D002549:Diffuse Cerebral Sclerosis of Schilder / Q000175:diagnosis* / Q000188:drug therapy; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D021621:Imaging, Three-Dimensional; D008775:Methylprednisolone / Q000627:therapeutic use*; D012074:Remission Induction
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Balos concentric sclerosis; demyelination; diffusion tensor imaging; magnetic resonance imaging; tractography