Friday, September 2, 2011

"Coolest Picture Ever" of Baló’s Concentric Sclerosis

Dr. Mark Cohen, neuropathologist at Case Western Reserve University, sent me these "Images in Clinical Medicine" from the August 25, 2011 edition of the New England Journal of Medicine.  The accompanying text is as follows:

"A 25-year-old, left-handed man with known relapsing–remitting multiple sclerosis presented with a mild, nonfluent aphasic syndrome and left facial paresis that had developed within the previous 5 days. Magnetic resonance imaging (MRI) scans of the brain revealed a large lesion with a concentric-ring pattern consisting of alternating bands of higher and lower signal intensity (axial T2-weighted image above; sagittal image below). Although large in diameter, the lesion had only a minor mass effect. Baló’s concentric sclerosis, described in 1928 by Jószef Baló as a variant of acute multiple sclerosis, is histopathologically characterized by alternating layers of myelinated and demyelinated tissue. On MRI, Baló-like lesions are defined as two or more alternating bands of differing signal intensities. They may occur as solitary lesions, along with the plaques typically seen in multiple sclerosis, or (rarely) in the context of other disorders, such as neuromyelitis optica or viral infections of the central nervous system. The patient’s symptoms responded well within 1 week after the start of high-dose intravenous glucocorticoid therapy. On follow-up imaging 4 weeks later, both the size of the lesion and gadolinium enhancement had decreased."

Dr. Cohen's comment: "Coolest picture ever (if only it had path to go with it)." Agreed.