Progressive Multifocal Leukoencephalopathy: MRI

Case Report: 43 y Male, known retroviral  status with altered sensorium for MRI shows-Diffuse non-enhancing  T2 and FLAIR white matter hyperintensity in supratentorial white matter in all the lobes, middle cerebellar peduncles, right thalamus, corpus callosum  with mild mass effect over sulcal spaces& ventricles with subtle bright signal in DWI with sparing of grey matter& subcortical U fibers with unremarkable flow voids, dural sinuses,optic chiasm/intraventricular extension, midline extension. Prominent subependymal vessels& pachymeninges seen on contrast without nodularity. These findings are likely suggestive of progressive multifocal leukoencephalopathy, in view of retroviral status.Teaching Points by Dr MGK Murthy , Dr GA Prasad, MR Tech Sudhakar Demyelinating disease  of CNS caused by reactivation of JC virus in immunocompromised pts. Typically seen in AIDS, transplant recepients, leukemia, in association with natalizumab treatment for Crohn disease and multiple sclerosis, monoclonal therapies.  80% of adults have anti JC antibodies normally.Definitive diagnosis of PML requires neuropathologic demonstration of the typical histopathologic triad (demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei) coupled with the techniques to show the presence of JC virus. The presence of clinical and imaging manifestations consistent with the diagnosis and not better explained by other disorders coupled with...

Source: Sumer's Radiology Site - March 6, 2017 Category: Radiology Authors: Sumer Sethi Source Type: blogs