Balo concentric sclerosis (3)

This 4-year-old patient had a history of flaccid paralysis of the left arm and leg and focal seizure of the left arm. Prior MRI showed a large right occipital lesion that involved the splenium and enhanced strongly in its periphery. A biopsy of the lesion revealed demyelination. A lumbar puncture showed no abnormality of cells, a normal IgG index, and no oligoclonal bands. The patient was well until 4 months later, when she developed right facial twitching followed quickly by facial weakness on the right and slurred speech. She was admitted to the hospital where this MRI scan showed a new large left parietal lesion consistent with Balo concentric sclerosis. (Left) Unenhanced T2-weighted scan. (Right) enhanced T1-weighted scan. (Contributed by Dr. Michael Kaufman.)