Grasso Daniela, Borreggine Carmela, Castorani Giulia, Vergara Doriana, Dimitri Lucia Maria Cecilia, Catapano Domenico, Simeone Annalisa, Popolizio Teresa
Department of Diagnostic Imaging, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
Diagnostic Imaging, Postgraduate Medical School, University of Foggia, Foggia, Italy.
SAGE Open Med Case Rep. 2020 Jul 17;8:2050313X20940532. doi: 10.1177/2050313X20940532. eCollection 2020.
Baló's concentric sclerosis is a rare variant of multiple sclerosis. It belongs to the group of primary inflammatory central nervous system demyelinating diseases having no clear etiology. Peculiar radiological findings on magnetic resonance imaging are alternating rings of demyelinated and myelinated axons resembling an "onion bulb." We report on a case of a patient with cocaine abuse who presented with Balò's-like acute multifocal leukoencephalopathy supported by histological and radiological findings. The abuse of cocaine and its most frequent adulterant, levamisole, may induce ischemic or hemorrhagic stroke and metabolic or multifocal inflammatory leukoencephalopathy. Only a few studies described levamisole-induced leukoencephalopathy mimicking Balò round lesions. Nevertheless, it has not yet been established the correlation between them; it might also be possible that the cocaine/levamisole addiction represents just a coincidence in some of those patients affected by Balò sclerosis disease.
巴洛同心性硬化是多发性硬化的一种罕见变体。它属于原发性炎症性中枢神经系统脱髓鞘疾病，病因尚不明确。磁共振成像上独特的影像学表现为脱髓鞘和有髓轴突交替出现的环，类似“洋葱球”。我们报告了一例可卡因滥用患者，其临床表现为类似巴洛样急性多灶性白质脑病，并有组织学和影像学检查结果支持。可卡因及其最常见的掺杂物左旋咪唑的滥用可能会诱发缺血性或出血性中风以及代谢性或多灶性炎症性白质脑病。仅有少数研究描述了左旋咪唑诱发的类似巴洛圆形病灶的白质脑病。然而，它们之间的相关性尚未确立；在一些患有巴洛硬化症的患者中，可卡因/左旋咪唑成瘾也可能只是一种巧合。
