Disclosures: George Schilling, DO: No financial relationships or conflicts of interest

Case Description: The patient had a 1 year history of the multiple sclerosis (MS) subtype Baló’s concentric sclerosis (Baló’s disease). She was on dimethyl fumarate but reported missing around 2 doses per week. She initially presented with 5 days of right-sided hemiparesis, confusion, and gait disturbances. MRI showed a new enhancing lesion in the right brachium pontis. She was started on a course of IV methylprednisolone with some relief in symptoms. She was admitted to inpatient rehabilitation where her dizziness and gait disturbances improved with scopolamine, meclizine, diazepam, neuromuscular reeducation, and visual-perceptual retraining.

Setting: Academic Acute Inpatient Rehabilitation Hospital

Patient: A 23-year-old female with Baló’s disease Assessment/

Results: MRI of the brain was significant for a new enhancing lesion in the right brachium pontis. MRI of the spine was negative for demyelinating lesions.

Discussion: Baló’s disease is a rare subtype of MS characterized by concentric layers of demyelinated tissue on imaging studies. These concentric layers are of bands of intact healthy myelin alternating with rings of loss of myelin and differentiate it from typical MS. Although the pathophysiology is unknown, it is theorized that this pattern is due to physiological hypoxia leading to expression of stress proteins at the border. Baló’s disease also distinguishes itself from MS by often being rapidly progressive rather than waxing and waning, although there have been more recent reports of prolonged survival or spontaneous remission. Patients with this MS subtype can benefit from intensive inpatient rehabilitation.

Conclusion: Baló’s disease is a rare subtype of multiple sclerosis. While rare, the current standard therapy is similar to multiple sclerosis. These patients can benefit from an intensive inpatient rehabilitation program.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/inpatient-rehabilitation-of-balos-disease-a-case-report/