Progressive multiphocal leukoencephalopathy

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JC virus (polyomavirus)

Risk factors

Immunodeficiency Predominantly involved the cortical white matter (brainstem and cerebellum may be involved)

Presentation

Hemiparesis

  • Speech, vision and gait abnormalities
  • Occasionally, CNs are affected

Diagnosis

MRI: multiple demyelinating non-enhancing lesions without mass effect

Treatment

None

Differential diagnosis

  • Toxoplasmosis (ring-enhancing, multiple, located in the basal ganglia)
  • CNS lymphoma (weakly ring-enhancing, solitary, periventricular, EBV DNA in CSF)
  • AIDS dementia complex (cortical and subcortical atrophy with 2ary ventricular enlargement)