DIAGNOSTIC-CRITERIA AND CLINICAL PROCEDURES IN HIV-1 ASSOCIATED PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

Citation
Hj. Vangiesen et al., DIAGNOSTIC-CRITERIA AND CLINICAL PROCEDURES IN HIV-1 ASSOCIATED PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY, Journal of the neurological sciences, 147(1), 1997, pp. 63-72
Citations number
68
Categorie Soggetti
Neurosciences
ISSN journal
0022510X
Volume
147
Issue
1
Year of publication
1997
Pages
63 - 72
Database
ISI
SICI code
0022-510X(1997)147:1<63:DACPIH>2.0.ZU;2-S
Abstract
The diagnosis of definite progressive multifocal leukoencephalopathy ( PML) has been a neuropathological domain. We reviewed all Human Immuno deficiency Virus Type 1 (HIV-I) seropositive patients in our instituti on between 01.01.1989 and 31.12.1994 and identified 20/823 cases with PML by clinical and imaging criteria. Diagnosis was neuropathologicall y confirmed in 5 cases. Diagnostic criteria included rapid onset (<2 w eeks) of multifocal neurological signs and symptoms, advanced immunosu ppression and asymmetric uni- or multifocal white matter lesions witho ut mass effect, contrast enhancement or cortical atrophy in magnetic r esonance imaging (MRI). The overall incidence of PML was stable over t he observation period (congruent to 2.5%). The mean age at onset (41.7 years) was significantly lower compared to HIV-1 seronegative PML pat ients (peak in the sixth decade of life), male patients prevailed (100 %). Mean survival (3.9 months) was extremely short. Human polyoma viru s JC (JCV) polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) demonstrated a considerable rare of possible cerebral co-infecti on with HIV-1 and JCV as well as subclinical infection with JCV. There fore demonstration of JCV deoxyribonucleic acid by PCR in the CSF alon e is not sufficient for clinical PML diagnosis. We present diagnostic criteria on the basis of epidemiological, neuroradiological and CSF pa rameters that allow us to make the clinical diagnosis of PML. Although quick and safe, routine stereotactic brain biopsy is not necessary to confirm the diagnosis. (C) 1997 Elsevier Science B.V.