Progressive multi-focal leucoencephalopathy

Progressive multi-focal leucoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the JC virus.  Despite many people being infected by the JC virus PML is very rare, generally only occurring in association with conditions such as:
  • HIV
  • CLL
  • patients on natalizumab

Presentations include:
  • motor weakness
  • impaired vision
  • mental changes
  • speech abnormalities
  • seizures

  • CT: subcortical hypodensities
  • MRI: hyperintense lesions on T2-weighted images, hypointense on T1-weighted images
  • CSF: often normal; do PCR on CSF for JC virus

  • in patients with HIV: start HAART
  • in patients on natalizumab: stop natalizumab and initiate plasmapheresis

Prognosis: generally very poor. 

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Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)