Problems of early diagnostics of rare demyelinating diseases: A case report

Objective: Concentric sclerosis of Balo is a rare demyelinating disease belonging to the group of multiple sclerosis, characterized by a specific "layered" structure of brain damage.The purpose of the work is to present a case of Balo`s concentric sclerosis and emphasize the importance of timely recognition of rare forms of demyelinating diseases for choosing adequate patient management tactics.Case presentation: We present a clinical case of a young patient with an acute onset of the disease, occurring with focal neurological symptoms and rapid progression.A clinical and instrumental analysis of a case of Balo's concentric sclerosis in a female patient was performed using a neurological examination, magnetic resonance imaging (MRI) of the brain with contrast, and laboratory studies to exclude other demyelinating and inflammatory diseases MRI revealed characteristic concentric layered lesions with signs of active inflammation.The clinical picture and dynamics of the disease confirmed the diagnosis of Balo's concentric sclerosis.The patient received immunosuppressive therapy (methylprednisolone) and plasmapheresis, with positive dynamics of neurological symptoms especially restoration of strength in the limbs.Conclusion: Thus, Balo`s concentric sclerosis presents in female patient with history of viral infection, focal neurological symptoms as hemiparesis and at early stages the imaging may indicate tumor or infection.MRI is informative and shows specific sign for Balo`s concentric sclerosis -layered myelinated and demiyelinated lesions or ``bulls eye`` sign.Immunosuppresive therapy results in improvement of symptoms.Take-home message: In patients with focal neurological symptoms developed after viral infection and pseudotumor or infection signs on initial imaging studies, repeated MRI imaging helps to establish the diagnosis of Balo`s concentric sclerosis and assist selecting proper therapy.

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