Esclerosis concéntrica de Baló con desenlace fatal.

Resumen

Introduction: Balló's concentric sclerosis (BCS) is a rare variant of multiple sclerosis (MS) that causes damage to myelin, forming concentric rings (like an onion skin) in the white matter of the brain, which are visible on magnetic resonance imaging. It presents with acute or subacute neurological symptoms such as headaches, weakness, cognitive problems, or epileptic seizures. Although it was historically considered fatal, it is now understood that its course is variable and sometimes responds well.

Clinical case: A 62-year-old man with type II diabetes and obesity experienced a sudden onset of right hemiparesis, headache, and stupor. Mild leukocytosis was documented in laboratory tests; electrolytes and CSF were normal. MRI revealed a 6 cm ovoid lesion with edema and ring enhancement. Spectroscopy showed decreased NAA, increased choline, and lactate. Treatment included methylprednisolone pulses and immunomodulators.

Discussion: ECB can mimic tumors or abscesses; early diagnosis helps avoid unnecessary surgeries. T2/FLAIR images display concentric rings, and T1 with gadolinium shows peripheral enhancement. Spectroscopy helps differentiate demyelinating lesions from neoplasms (↓ NAA, ↑ choline, lactate). CBD is a rare variant of multiple sclerosis, generally benign, although this case resulted in a fatal outcome.

Conclusion: In this case, low doses of steroids were administered, which were associated with a fatal progression.