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Progressive multifocal leukoencephalopathy: unusual MR findings

S Ng1, V C Tse, J Rubinstein

  • 1Department of Radiology, Stanford University School of Medicine, CA 94305.

Journal of Computer Assisted Tomography
|March 1, 1995
PubMed

Insights

This case report details progressive multifocal leukoencephalopathy (PML) with atypical imaging findings, including prior hemorrhage and contrast enhancement visible only with specific MRI techniques. Redefining diagnostic criteria for PML may be necessary.

Area of Science:

  • Neuroimaging
  • Neuropathology
  • Infectious Diseases

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, demyelinating disease affecting the central nervous system, typically caused by the JC virus.
  • Standard diagnostic criteria rely on characteristic clinical, radiological, and pathological features.

Observation:

  • A patient presented with classic clinical symptoms of PML.
  • However, pathological examination revealed evidence of prior cerebral hemorrhage, an unusual finding.
  • Radiographic studies showed focal cerebral atrophy and contrast enhancement on MRI.

Findings:

  • Contrast enhancement in PML lesions was only detectable using magnetization transfer (MT) pulses on T1-weighted MRI sequences.
  • This highlights the sensitivity of MT imaging in visualizing subtle pathological changes.

Implications:

  • The unusual imaging and pathological findings challenge current diagnostic standards for PML.
  • This case suggests a need to re-evaluate and potentially expand the imaging criteria used for diagnosing PML.
  • Further research into advanced MRI techniques like MT may improve PML detection and characterization.

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