Gavra Maria, Boviatsis Efstathios, Stavrinou Lampis C, Sakas Damianos
Department of CT and MRI, Children's Hospital, "Agia Sophia'', Thivon and Papadiamantopoulou Street, Athens, Greece.
J Med Case Rep. 2011 Jun 7;5:217. doi: 10.1186/1752-1947-5-217.
In rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors. We report a patient with a space-occupying lesion in the parietal lobe, which presented a serious diagnostic dilemma, between a rare tumefactive demyelinating disease, such as Balo concentric sclerosis and a glioma. This case report highlights important diagnostic clues in the differential diagnosis of Balo concentric sclerosis.
A 20-year-old Caucasian woman with acute onset of left-sided weakness and numbness was admitted to hospital with neurologic signs of left-sided hemiparesis and hypoesthesia. Brain magnetic resonance imaging showed a mass lesion of abnormal signal intensity with concentric enhancing rings in the right parietal lobe, without perifocal edema. The characteristic concentric pattern detected on the magnetic resonance images was highly suggestive of Balo disease, and corticosteroids were administered. Evoked potentials, cerebrospinal fluid analysis, and magnetic spectroscopy findings were not specific, and glioma was also included in the differential diagnosis. A stereotactic biopsy was not diagnostic.After one month the patient showed moderate clinical improvement, and during 12 months follow-up, no further relapses occurred. In the follow-up magnetic resonance imaging, the concentric pattern had completely disappeared, and only a low-signal, gliotic lesion remained.
We hope this case presentation will advance our understanding of clinical and radiologic appearance of Balo concentric sclerosis, which is a rare demyelinating disease. Although this is a specific entity, it has a broader clinical impact across medicine, because it must be differentiated from other space-occupying lesions in the central nervous system.
在罕见情况下，脱髓鞘疾病表现为类似脑肿瘤的肿胀性病变。我们报告了一名顶叶有占位性病变的患者，该病变在一种罕见的肿胀性脱髓鞘疾病（如巴洛同心性硬化）和胶质瘤之间造成了严重的诊断困境。本病例报告突出了巴洛同心性硬化鉴别诊断中的重要诊断线索。
一名20岁的白种女性，急性起病出现左侧肢体无力和麻木，因左侧偏瘫和感觉减退的神经学体征入院。脑部磁共振成像显示右侧顶叶有一个信号强度异常的肿块病变，伴有同心性强化环，周围无水肿。磁共振图像上检测到的特征性同心模式高度提示巴洛病，遂给予皮质类固醇治疗。诱发电位、脑脊液分析和磁共振波谱结果均不具有特异性，胶质瘤也被列入鉴别诊断。立体定向活检未能明确诊断。一个月后患者临床症状有中度改善，在12个月的随访中未再复发。在随访的磁共振成像中，同心模式已完全消失，仅留下一个低信号的胶质增生性病变。
我们希望本病例报告能增进我们对巴洛同心性硬化这种罕见脱髓鞘疾病的临床和影像学表现的理解。尽管这是一种特定的疾病实体，但它在医学领域具有更广泛的临床影响，因为它必须与中枢神经系统的其他占位性病变相鉴别。
