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Isolated pontine progressive multifocal leukoencephalopathy: unusual magnetic resonance imaging features
Devon I Rubin1, Steven Norris, Robert Flint
1Department of Neurology, Mayo Clinic, Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA. rubin.devon@mayo.edu
Abstract:
Progressive multifocal leukoencephalopathy (PML) is an uncommon opportunistic infection that causes focal or multifocal demyelination predominantly in the subcortical white matter. The authors describe the clinical and radiographic features in 2 unusual cases of PML that were initially isolated to the pons. One patient presented clinically with only an isolated sixth cranial nerve palsy.
Insights
Progressive multifocal leukoencephalopathy (PML) can present unusually, even when isolated to the pons. These rare cases highlight atypical neurological symptoms, such as isolated sixth cranial nerve palsy, in PML.
Area of Science:
- Neuroscience
- Infectious Diseases
- Radiology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic infection affecting the central nervous system.
- PML typically causes demyelination in the subcortical white matter.
- It is often associated with immunosuppression.
Observation:
- Two unusual cases of PML were identified.
- These cases presented with initial isolation to the pons.
- One patient exhibited an isolated sixth cranial nerve palsy.
Findings:
- The study details the clinical and radiographic features of these atypical PML presentations.
- PML's potential for focal neurological deficits, even when pons-centric, is demonstrated.
- Radiographic and clinical correlation is crucial for diagnosing unusual PML cases.
Implications:
- These findings expand the understanding of PML's diverse clinical manifestations.
- Awareness of pontine-isolated PML is important for neurologists and infectious disease specialists.
- Early recognition of atypical PML symptoms can lead to timely diagnosis and management.