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Updated: Apr 26, 2026

Exergaming in Older People Living with HIV Improves Balance, Mobility and Ameliorates Some Aspects of Frailty
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Cerebellar Dysfunction in a Patient with HIV.

Fernando Gonzalez-Ibarra1, Waheed Abdul2, Sahar Eivaz-Mohammadi1

  • 1Department of Internal Medicine, Jersey City Medical Center, Mount Sinai School of Medicine, 355 Grand Street, Jersey City, NJ 07302, USA.

Case Reports in Neurological Medicine
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Summary

A cerebellar disorder in an AIDS patient was diagnosed as JC virus-associated granule cell neuronopathy (GCN). This neurological condition presents with cerebellar symptoms and is confirmed via PCR and potentially biopsy.

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Area of Science:

  • Neurology
  • Virology
  • Immunology

Background:

  • Cerebellar symptoms can arise from various opportunistic infections in immunocompromised individuals, particularly those with advanced Human Immunodeficiency Virus (HIV) infection.
  • JC virus (JCV) is a common human polyomavirus that can cause progressive multifocal leukoencephalopathy (PML), but JCV-associated granule cell neuronopathy (GCN) is a rarer presentation.

Purpose of the Study:

  • To investigate the cause of new-onset cerebellar dysfunction in an individual with advanced Acquired Immunodeficiency Syndrome (AIDS).
  • To identify the specific pathogen responsible for the neurological deficits and guide potential therapeutic strategies.

Main Methods:

  • Clinical presentation and neurological examination were assessed.
  • Cerebral Magnetic Resonance Imaging (MRI) was performed to evaluate structural brain abnormalities.
  • Cerebrospinal fluid (CSF) analysis included cell counts, protein levels, serological tests, cryptococcal antigen, Venereal Disease Research Laboratory (VDRL) test, microbial cultures, and Polymerase Chain Reaction (PCR) assays for specific viruses.
  • JC virus DNA levels in CSF were quantified using PCR.

Main Results:

  • The patient presented with distinct cerebellar signs including left cranial nerve XI weakness, gait ataxia, dysmetria, and dysdiadochokinesia.
  • MRI revealed hyperintensity in the left inferior cerebellar hemisphere.
  • CSF analysis showed elevated protein and white blood cell count (lymphocytic pleocytosis), with negative results for HSV, syphilis, and Cryptococcus.
  • CSF PCR assay was positive for JC virus with a high viral load (1,276 copies).

Conclusions:

  • The clinical and radiological findings, coupled with the positive CSF JC virus PCR, strongly suggest JC virus-associated granule cell neuronopathy (GCN) as the cause of cerebellar dysfunction in this AIDS patient.
  • While JCV-associated GCN is a rare manifestation, it should be considered in the differential diagnosis of cerebellar syndromes in severely immunocompromised individuals.
  • Definitive diagnosis of GCN typically requires brain biopsy with immunohistochemistry, though PCR confirmation of JCV in CSF is highly suggestive.