Abstract
IntroductionIn rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors. We report a patient with a space-occupying lesion in the parietal lobe, which presented a serious diagnostic dilemma, between a rare tumefactive demyelinating disease, such as Balo concentric sclerosis and a glioma. This case report highlights important diagnostic clues in the differential diagnosis of Balo concentric sclerosis.Case presentationA 20-year-old Caucasian woman with acute onset of left-sided weakness and numbness was admitted to hospital with neurologic signs of left-sided hemiparesis and hypoesthesia. Brain magnetic resonance imaging showed a mass lesion of abnormal signal intensity with concentric enhancing rings in the right parietal lobe, without perifocal edema. The characteristic concentric pattern detected on the magnetic resonance images was highly suggestive of Balo disease, and corticosteroids were administered. Evoked potentials, cerebrospinal fluid analysis, and magnetic spectroscopy findings were not specific, and glioma was also included in the differential diagnosis. A stereotactic biopsy was not diagnostic.After one month the patient showed moderate clinical improvement, and during 12 months follow-up, no further relapses occurred. In the follow-up magnetic resonance imaging, the concentric pattern had completely disappeared, and only a low-signal, gliotic lesion remained.ConclusionWe hope this case presentation will advance our understanding of clinical and radiologic appearance of Balo concentric sclerosis, which is a rare demyelinating disease. Although this is a specific entity, it has a broader clinical impact across medicine, because it must be differentiated from other space-occupying lesions in the central nervous system.
Highlights
In rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors
We report a patient with a right parietal white matter lesion, who presented a serious diagnostic dilemma, as the lesion was difficult to differentiate between a rare demyelinating disease such as Balo concentric sclerosis (BCS) and a glioma
The characteristic magnetic resonance findings of the case, its acute onset, and its clinical improvement after corticosteroid therapy set the diagnosis of BCS
Summary
Demyelinating diseases can mimic brain neoplasms clinically, radiologically, and histopathologically. The typical concentric pattern on MR images, along with clinical features, can lead to accurate diagnosis and treatment. 6. Xia L, Lin S, Wang ZC, Li SW, Gao CC: Tumefactive demyelinatig lesions: nine cases and a review of the literature. 8. Sugita Y, Terasaki M, Shigemori M: Acute focal demyelinating disease simulating brain tumors: histopathologic guidelines for an accurate diagnosis. Doi:10.1186/1752-1947-5-217 Cite this article as: Gavra et al.: Pitfalls in the diagnosis of a tumefactive demyelinating lesion: A case report. Journal of Medical Case Reports 2011 5:217. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Author details 1Department of CT and MRI, Children’s Hospital, “Agia Sophia’’, Thivon and Papadiamantopoulou Street, Athens, Greece. Competing interests The authors declare that they have no competing interests
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