PMC4386112_01
a Axial T1W MRI (baseline MRI) shows a 2 cm sized well-circumscribed hypointense lesion in the left centrum semiovale. b Corresponding axial T2W MRI shows ill-defined concentric bands within the lesion. There is minimal peri-lesional oedema. c Corresponding contrast-enhanced coronal T1W MRI shows concentric enhancement within the lesion, which is pathognomonic of BCS. d Corresponding axial FLAIR image shows the Balo lesion along with a simultaneous small ovoid hyperintense lesion in the left peri-trigonal white matter. These findings indicate associated MS.
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F1
T1W images and alternate hypo-/hyperintensity on T2W/FLAIR images (fig. 1a, b). There was mild associated peri-lesional oedema. A concentric pattern of post-contrast enhancement was noted within the lesion (fig. 1c), and a rim of restricted diffusion was seen along the margins of the lesion. Few smaller 3- to 5-mm sized ovoid T2/FLAIR hyperintense MS-like lesions were also noted in the peri-ventricular and subcortical white matter (fig. 1d).
a Axial T2W MRI (follow-up MRI at 4 months) shows very well delineated concentric rings within the Balo lesion. No peri-lesional oedema is seen. b Corresponding contrast-enhanced axial T1W MRI shows interval regression of the previously noted contrast enhancement within the lesion.
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F2
Balo lesion with regression of previously noted peri-lesional oedema, restricted diffusion and post-contrast enhancement (fig. 2). Because of the additional typical MS lesions on the MRI scan and the positive oligoclonal bands in the CSF, she was started on immunomodulatory medication with interferon beta-1b.