January 31, 2011 (MAIN)
63-year-old HIV-positive woman with rapidly progressive memory impairment.
Progressive Multifocal Leukoencephalopathy
- Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by JC papovavirus.
- Most commonly seen in the HIV population. 20% of the cases are seen in other immunocompromised states, including rheumatologic, hematologic and oncologic conditions. Rarely, seen in immunocompetent population.
- Diagnosis can be confirmed only on histology. However, the diagnosis can be established if there is a correlation between the clinical pr, imaging appearance, and positive PCR on CSF analysis.
- Key Diagnostic Features: MR is the imaging modality of choice. Large, multifocal, asymmetric, predominantly white matter lesions, extending to involve the subcortical white matter, without any obvious mass effect are seen. Diffusion restriction and enhancement can be seen along the advancing edge of demyelination.
- DDx: HIV encephalopathy, Lymphoma, Tumefactive MS.
- Rx: HAART
January 31, 2011 (COMPANION)
63-year-old man with hepatitis C, cirrhosis, hepatocellular carcinoma, s/p liver transplant with marked mental status changes.
