In this great MR case, we learned about the work up of subacute neurological changes in a young male. The important points to take home were:
- The differential for neurological changes is very different depending on:
- Timing (acute, subacute, chronic)
- Progression (fast or slow)
- Immune status
- What is the differential for neurological changes in a young HIV infected patient?
- Direct consequence of HIV –> HIV-associated neurocognitive disorders (like HIV-dementia)
- Opportunistic infections –> Toxo, fungi, TB, viruses (PML, CMV, HSV)
- Neoplasms –> primary CNS lymphoma
- Complication of treatment –> IRIS
- PML is rare but how would you identify it by history and imaging?
- Immunocompromised patient (frequently HIV, lymphoma/leukemia, patients receiving natalizumab)
- Subacute, progressive neurological changes that include behavior, cognition AND focal neurological deficits
- MRI with bilateral, symmetrical or asymmetrical demyelinating disease. NEVER involves optic nerve.