Clinical Snapshot
Fulminant Balo Disease
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Over a period of 1 week, a 52-year-old man developed abnormal fatigue, dysarthria, and moderately severe tetraparesis. Initial magnetic resonance imaging showed bilateral round areas of demyelination, also in the pons. Moreover, examination of cerebrospinal fluid demonstrated pleocytosis and positive oligoclonal bands. We diagnosed acute demyelinating encephalomyelitis. Administration of high-dose cortisone and plasmapheresis brought about no improvement. The patient has been in a coma since resuscitation due to the sudden occurrence of asystole. Repeat magnetic resonance imaging (after 7 weeks) demonstrated enlargement of the demyelination foci, including locations in the entire pons and the reticular formation, as an explanation for the coma. Some of these lesions now showed the pathognomonic features of concentric Balo sclerosis, i.e., annular areas of demyelination with narrow rings of preserved or regenerated myelin (Figure). Typically, the ring-shaped T2-hyperintense lesions take up to a month to become evident. This disease is viewed as a subtype of multiple sclerosis. It usually shows an acute, monophasic course, with 10% of cases leading to death within 1–2 months. Half of the patients respond to treatment with prednisolone.
Dr. med. Dirk Bandorski, Daniela Degner, Dr. med. Jens Allendörfer, Semmelweis Universität Hamburg, dirk.bandorski@t-online.de
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Bandorski D, Degner D, Allendörfer J: Fulminant Balo disease. Dtsch Arztebl Int 2022; 119: 490b. DOI: 10.3238/arztebl.m2022.0034
