NEUROOPHTHALMIC FINDINGS IN PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

Background: Progressive multifocal leukoencephalopathy (PML) is a demy elinating disorder of the central nervous system found in immunodefici ent patients, most frequently now in those infected with HIV, It may r epresent the initial manifestation of HIV infection, Since the central visual pathways may be affected, a variety of neuro-ophthalmic signs and symptoms can manifest. We studied the clinical, radiographic and h istopathological characteristics of patients with PML. Methods: The ch arts of 13 patients in whom PML was diagnosed in the Neuro-AIDS clinic at the Montreal Neurological Institute between November 1987 and Marc h 1995 were reviewed. The diagnosis of PML was established by characte ristic clinical features together with typical computed tomographic or magnetic resonance imaging findings, such as nonenhancing low-density (on computed tomography) or hyperintense (on T-2-weighted magnetic re sonance imaging) white-matter lesions, without mass effect. Neuro-opht halmic findings were based on clinical examination by an ophthalmologi st, neuro-ophthalmologist or neurologist. Tissue for pathological exam ination was obtained by biopsy in one case and at postmortem study in a second case. Results: The most common finding was homonymous hemiano pia, in five patients (38%), Other features included nystagmus (in two patients), diplopia with cranial nerve palsy (in one) and cortical bl indness (in one). One of the patients exhibited involvement of the bra in stem, a site not usually affected by this demyelinating process, In terpretation: The diagnosis of PML should be considered in immunocompr omised patients with neuro-ophthalmic findings, particularly those wit h homonymous hemianopia.