Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 4
Disclosures: Amber N. Clark, MD: Nothing to disclose
Case Description: A 34-year-old African-American female presented from an outside facility for evaluation of acute worsening of progressive right sided weakness and aphasia of 3 weeks duration. CT head without contrast was concerning for a large left MCA infarct. Sequential MRI studies showed a large left frontal enhancing lesion. Physical exam findings included extensive right hemisensory loss, 0/5 on MMT of RUE and RLE, right sided hyperreflexia and evidence of transcortical motor aphasia. Further MRI findings showed classic concentric rings of the lesion and vasogenic edema. The patient was diagnosed with Balo’s Concentric Sclerosis. Treatment included IV salumedrol with 5 sessions of PLEX therapy following. She was admitted to inpatient rehabilitation (IPR) following her acute hospitalization for 2 weeks of intense multi-disciplinary therapy. At the time of discharge from IPR, she had improved in all 3 therapy domains with at least 2 point improvements in FIM score and was scheduled to follow with the Multiple Sclerosis (MS) Clinic. A thorough immunological workup along with clinical symptomology and repeat MRI imaging resulted in a diagnosis of relapsing remitting MS.
Setting: Inpatient Rehabilitation Hospital
Patient: A 34-year-old African-American female with sub-acute onset right sided weakness and aphasia.
Assessment/Results: Four months following IPR discharge, the patient began natilizumab. Following, she experienced no relapses and had continued improvements in speech, strength, coordination and ADL independence. Further developments will be discussed.
Discussion: Balo’s Concentric Sclerosis is a rare demyelinating disease that is often regarded as a variant of MS. The majority of what is known about this disease is secondary to case reports. This clinical vignette seeks to add to the growing pool of data regarding this diagnosis.
Conclusion: While relatively rare, recognition and knowledge of the nature of this disease is important to the rehabilitation physician in order to better anticipate patients’ current and future rehabilitation needs.
Level of Evidence: Level V
To cite this abstract in AMA style:Clark AN. An Acute Presentation of Balo’s Concentric Sclerosis with Progression to Relapsing Remitting Multiple Sclerosis: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/an-acute-presentation-of-balos-concentric-sclerosis-with-progression-to-relapsing-remitting-multiple-sclerosis-a-case-report/. Accessed September 28, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-acute-presentation-of-balos-concentric-sclerosis-with-progression-to-relapsing-remitting-multiple-sclerosis-a-case-report/