Balo's concentric sclerosis or multiple sclerosis? A demyelinating disease in a 36-year-old woman

Abstract

A 36-year-old women developed dysarthria, dizziness, right-sided weakness, bilateral clumsiness, unsteady gait and fever (37.3 (cid:1) C) 1 day after a cold. The symptoms were aggravated 5 days later. The right limb was completely immobile. She could not understand the speech of others and could not be understood by others. Two days after the aggravation, high-dose methylprednisolone pulse therapy was given (1000 mg/day for 4 days, then 500 mg/day for 2 days), but her condi-tion continued to deteriorate. The patient was admitted to our hospital 14 days after the onset of the disease. On admission, the right muscle strength was grade 0, with low muscular tone and enhanced deep tendon reflexes. The right patellar clonus, ankle clonus, the Babinski sign and the Chaddock sign were positive. Magnetic resonance imaging (MRI) of the brain showed multiple lesions in bilateral frontal lobes, parietal lobes, lateral ventricle, basal ganglia regions, hippocampus, left thalamus, left occipital lobe, right cerebellar hemisphere, left brainstem and splenium of the corpus cal-losum. Unclassical concentric circle-like bands on T1- and T2-weighted images, fluid-attenuated inversion diffusion-weighted No in the post-contrast T1-weighted