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Case No. 591
2021-06-01~2021-06-30
출제자 : 이경식
Hit : 440
| Period | 2021-06-01~2021-06-30 |
|---|---|
| Diagnosis | Progressive multifocal leukoencephalopathy (PML) |
| Gender |
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| Age | 32 |
| Clinical information | Hx: 두 달 전부터 발생한 우울증 등의 행동변화와 두통을 주소로 내원한 32세 남자환자의 MRI 영상입니다. 가능한 진단은? |
| Discussion | Progressive multifocal leukoencephalopathy (PML) Etiology: secondary to progressive demyelination due to John Cunningham (JC) virus which infects oligodendrocytes in HIV/AIDS patients. Typically CD4 cell count < 100/μL. Imaging feature: - Multifocal, asymmetric periventricular and subcortical involvement. - Little, or no mass effect or enhancement - Subcortical U-fibers: commonly involved with a predilection for the parieto-occipital regions. * MRI findings - T2WI: hyperintense, multiple punctate high T2 signal lesions surrounding the main area (milky way sign) - T1 C+ (Gd): typically no enhancement, enhancement can be seen in PML-IRIS, AIDS with HAART, and in patients on natalizumab. - ADC/DWI: peripheral patchy diffusion restriction particularly at the leading edge |
| Correct answer |
Correct Answer
Semi-Correct Answer |