Progressive multifocal leukoencephalopathy
This 36 year old lady with AIDS (newly diagnosed) presented with neurological deterioration. No fever. Had a CD count of 130cells/microlitre. CSF analysis excluded TB or pyogenic meningitis.
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There is bilateral periventricular and subcortical white matter T2 hyperintensities, more prominent around the trigone regions. There is relative sparing of the cortex. No significant associated mass effect. No brain swelling. Associated of diffusion restriction is evident on DWI.
Progressive multifocal leukoencephalopathy is a demylinating process results from JC virus infection and seen in advanced HIV infection, typically when CD4 counts of less than 150 cells/microlitre. Typical white matter lesions are multifocal, periventricular and subcortical (involving the u fibers).
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