Pediatric form of balo's concentric sclerosis: Case report

ABSTRACT

Introduction: This case presents the pediatric form of Baló's Concentric Sclerosis, which corresponds to 2.2% of demyelinating diseases in this age group, being more common in adults. It is characterized by concentric rings formed by demyelinated and myelinated fibers with an 'onion skin' pattern. In childhood, it has less functional impairment and a more benign course. Differential diagnosis with acute disseminated encephalomyelitis, primary central nervous system neoplasms and infections is a challenge. There is no consensus on treatment and corticosteroids have been used as the basis of therapy for acute injuries. Objectives: To report the case of a 13-year-old child with clinical and neuroimaging features characteristic of the disease and a good response to methylprednisolone. Methods: Review of medical records and literature search (PubMed). Results: A 13-year-old white male patient started paresthesia followed by paresis in the right side. After 1 month, he had complete recovery from symptoms without the use of medication. Cranial magnetic resonance imaging showed an oval lesion in the nucleocapsular region on the left with hypersignal on T2/FLAIR with diffusion restriction. Prescription Teriflunamide 14mg/day for the treatment of Multiple Sclerosis. Two years after the start of treatment, he presented paresis in his left side with dysphagia. On physical examination, athetosis in the left upper limb was observed. Symptoms were preceded by hypogeusia and hyposmia with serology for COVID IgG positive and IgM negative. Cranial magnetic resonance imaging revealed rounded areas on T2/FLAIR with enhancement and diffusion to restriction in the subthalamic region and occipital lobe on the right suggestive of active demyelinating plaques and lesion in the left frontal lobe with heterogeneous signal on T2. Methylprednisolone was prescribed IV for five days with significant improvement in athetosis and paresis. Conclusions: The pediatric form of Baló's disease is a rare disease with few cases reported in the literature and represents a diagnostic challenge and a therapeutic enigma.