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Tumefactive demyelination (TD) and Baló 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.
Footnotes
Author contributions: T.A.H. and B.G.W. conceived the idea for the manuscript. T.A.H. drafted the manuscript. All authors revised the manuscript critically for important intellectual content and gave final approval of the version to be published.
Study funding: No targeted funding reported.
Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- Received November 22, 2016.
- Accepted in final form March 2, 2017.
- © 2017 American Academy of Neurology
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