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Case No. 245
2011-07-04~2011-07-31
출제자 : 김진아
Hit : 460
| Period | 2011-07-04~2011-07-31 |
|---|---|
| Diagnosis | |
| Clinical information | 54세 남자, worsening of ataxia, dysarthria, and diplopia (T2WI, 첫 내원 당시; 다음FLAIR3장, 10일 후; FLAIR마지막3장, 35일 후) 진단은? |
| Discussion | Progressive multifocal leukoencephlopathy (in a patient with AIDS) Progressive multifocal leukoencephalopathy (PML) is a subacute demyelinating disease of the central nervous system caused by neurotropic JC virus and usually occurs in immunocompromised patients such as patients with acquired immunodeficiency syndrome (AIDS). The prevalence of PML ranges from 4% to 7% of AIDS patients and this disease is usually progressive and the mean survival time is 6-9 months. Asymmetric multifocal bilateral confluent supratentorial lobar white matter involvement without contrast enhancement is the most common manifestation. White matter of the posterior fossa is the next most common area of involvement. Typically the disease involves the middle cerebellar peduncle and adjacent pons and cerebellum. Characteristic DWI and ADC mapping features of PML lesions have high SI on DWI and normal-to-low SI on ADC maps at the peripheral margin, while have low SI on DWI and high SI on ADC maps at the center (layered phenomenon). 1H-MRS for patients with PML usually show an increase in lactate/Cr, Cho/Cr, and lipids/Cr ratios as well as a decrease in NAA/Cr ratio, compared to the normal contralateral region. These findings suggest that PML is demyelinating disease, therefore, 1H-MRS can be used to support the diagnosis of PML in patients with AIDS. References 1. Bag AK, Cur?JK, Chapman PR, Roberson GH, Shah R. JC Virus Infection of the Brain. AJNR Am J Neuroradiol 2010;31:1564-76. 2. Park BS, Yu IK, Lee BH. Progressive Multifocal Leucoencephalopathy Isolated to Posterior Fossa in a Patient with AIDS: DWI and 1H-MRS Features. J Korean Soc Radiol 2010;63:403-7. |
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