Abstract
Tumefactive demyelination (TD) and Balo concentric sclerosis (BCS) are subtypes of atypical demyelination that may overlap with each other and with prototypic multiple sclerosis (MS). TD and BCS can be distinguished by their different MRI appearance. BCS is associated with alternating rings of T2/fluid-attenuated inversion recovery hypointensity and hyperintensity that correlate pathologically with rings of tissue of varying degrees of demyelination. We present a patient whose initial MRI was consistent with TD but who later developed MRI characteristics in keeping with BCS, emphasizing the difficulty in distinguishing accurately between different subtypes of demyelination early in their course.
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