Morning report 7/11/17

Morning report 7/11/17

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:

  1. The differential for neurological changes is very different depending on:
    • Age
    • Timing (acute, subacute, chronic)
    • Progression (fast or slow)
    • Immune status
  2. 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
  3. 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.

 

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