Balo’s concentric sclerosis (BCS)

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Balo’s concentric sclerosis (BCS). This results from rings of inflammation around foci of demyelination. Fully referenced neurology checklist.

Pathology and epidemiology

  • This results from rings of inflammation around foci of demyelination
  • It has an onion ring or whorled appearance
  • It may co-exist with typical MS lesions
  • It is possibly an aquaporin 4 astrocytopathy
  • There is a high prevalence in Southern Han Chinese, Taiwanese, and Filipinos

Clinical patterns

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Clinical features

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Magnetic resonance imaging (MRI)

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Differential diagnosis

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Differences with multiple sclerosis (MS)

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Treatment

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Outcomes

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Acronym

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References

  1. Hardy TA, Miller DH. Baló’s concentric sclerosis. Lancet Neurol 2014; 13:740-746.
  2. Hardy TA, Corboy JR, Weinshenker BG. Baló concentric sclerosis evolving from apparent tumefactive demyelination. Neurology 2017; 88:2150-2152. 
  3. Darke M, Bahador FM, Miller DC, Litofsky NS, Ahsan H. Baló’s concentric sclerosis: imaging findings and pathological correlation. J Radiol Case Rep 2013; 7:1-8. 
  4. Purohit B, Ganewatte E, Schreiner B, Kollias S. Balo's concentric sclerosis with acute presentation and co-existing multiple sclerosis-typical lesions on MRI. Case Rep Neurol 2015; 7:44-50. 
  5. Chaodong Wang, Zhang KN, Wu XM, et al. Balo's disease showing benign clinical course and co-existence with multiple sclerosis-like lesions in Chinese. Mult Scler 2008; 14:418-424. 
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