Why is this Auntminnie a Diagnostic Conundrum? - A Knowledge-Based Approach to Balo’s Concentric Sclerosis from Reports of Three Cases and Pooled Data from Sixty-Eight other Patients in The Literature

Publication date: Available online 6 January 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Mohit Agarwal, John L. Ulmer, Andrew P. Klein, Leighton P. Mark
We came across three cases of Balo′s concentric sclerosis (BCS). The first of these patients presented to an outside hospital and was transferred to our institution due to complications resulting from a biopsy. The other two patients, despite having a characteristic imaging appearance and despite insistence on our part on the diagnosis of BCS, underwent a surgical procedure, which could have been prevented. This led us to review the available literature on BCS. 68 patients diagnosed with BCS between 1995 and 2015 were studied and the data collected for the clinical presentation and course, imaging, spinal fluid analysis, treatment, and clinical and imaging outcome. A 25% surgery rate (biopsy or resection) was found in the study. We concluded that this relatively high surgery rate in this auntminnie non-surgical disease is multifactorial; and includes factors like non-familiarity with the disease, anxiety on the part of patients and physicians, due to a sometimes rapidly deteriorating clinical picture; and resemblance of the disease with other entities such as tumor and infection. However, characteristic imaging appearance combined with acute/subacute presentation and dramatic improvement in clinical status after high dose steroid chemotherapy; are highly suggestive of the disease, and can prevent unnecessary surgery.



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