title: Exploring the overlap between multiple sclerosis, tumefactive demyelination and Baló's concentric sclerosis.
abstract: The availability of magnetic resonance imaging (MRI) has led to increasing recognition that multiple sclerosis (MS), tumefactive demyelination (TD) and Baló's concentric sclerosis (BCS) share many overlapping features. Baló-like lesions, which exhibit limited features of BCS, may represent an intermediate between BCS and typical MS demyelination. Lesions labeled as tumefactive are typically larger, but otherwise have much in common with conventional MS lesions, and TD and BCS lesions can also overlap. In this article, we explore the similarities between typical MS, TD and BCS cases, and reflect on the potential insights that intermediate or overlapping phenotypes may contribute towards an understanding of MS immunopathogenesis, and question whether these atypical forms of demyelination should be classified as separate demyelinating diseases, as different lesional manifestations of demyelination of any cause or as part of a spectrum with conventional MS.
authors.affiliation: Neuroimmunology Clinic, Department of Neurology, Concord Repatriation General Hospital, University of Sydney, Concord West, NSW, Australia/Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia thardy@med.usyd.edu.au.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hardy
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: W Oliver
authors.initials: WO
authors.lastname: Tobin
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Claudia F
authors.initials: CF
authors.lastname: Lucchinetti
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D003711:Demyelinating Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D002549:Diffuse Cerebral Sclerosis of Schilder / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis
keywords: Histopathology; atypical; immunopathogenesis; newly forming; pseudotumor