Presentation
Right-sided weakness.
Patient Data
Left frontoparietal white matter lesion involving centrum semiovale with concentric areas of alternating signal intensities showing outer T2 hypointense zone which show two concentric rings of enhancement and diffusion restriction denoting active lesion. Perifocal edema reaching subcortical and periventricular white matter is noted.
Few right frontal foci of white matter changes of high T2 and FLAIR signal, suggestive of demyelinating lesions.
'bullseye' or 'onion bulb' appearance in different pulse sequences.
Case Discussion
The lesion shows concentric alternating high and low bands on T2 weighted imaging giving a 'bullseye' or 'onion bulb' appearance, which raises the possibility of Baló concentric sclerosis, a rare variant of multiple sclerosis (MS).
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