eMedicine Specialties > Radiology > Brain/Spine

Progressive Multifocal Leukodystrophy: Follow-up

Author: Manohar Aribandi, MD, Academic Chief, Section of Neuroradiology, Department of Radiology, Geisinger Medical Center
Coauthor(s): Anil Kumar Aribandi, MBBS, MD, MRCP, Specialist Registrar, Department of Hematology, Manchester Royal Infirmary, UK
Contributor Information and Disclosures

Updated: Oct 14, 2009

Intervention

As of now, radiographically guided intervention has no role in the treatment of PML.

An antiretroviral regimen containing protease inhibitors has been successful in prolonging the survival of patients with HIV infection and PML. Topotecan and cidofovir are promising drugs presently under evaluation. The role of splenectomy remains unproven, though reports have described remission in association with HAART.

 


More on Progressive Multifocal Leukodystrophy

Overview: Progressive Multifocal Leukodystrophy
Imaging: Progressive Multifocal Leukodystrophy
Follow-up: Progressive Multifocal Leukodystrophy
Multimedia: Progressive Multifocal Leukodystrophy
References
Further Reading

References

  1. Anstrom KE, Mancall EL, Richardson EP Jr. Progressive multifocal leukoencephalopathy. Brain. 1958;81:93-127.

  2. ZuRhein GM. Association of papovavirus with a human demyelinating disease (progressive multifocal leukoencephalopathy). Prog Med Virol. 1969;11:185-247.

  3. Padgett BL, Walker DL, ZuRhein GM, et al. Cultivation of papova-like virus from human brain with progressive multifocal leucoencephalopathy. Lancet. 1971;1(7712):1257-1260. [Medline].

  4. Hua-Chuan Z, Lei Y, Lei C, Yi-Fu G, Yasuo T. Mapping the history and current situation of research on John Cunningham virus- a bibliometric analysis. BMC Infect Dis. Mar 11 2009;9(1):28. [Medline].

  5. Wang Y, Kirby JE, Qian Q. Effective use of JC virus PCR for diagnosis of progressive multifocal leukoencephalopathy. J Med Microbiol. Feb 2009;58:253-5. [Medline].

  6. Grabowski MK, Viscidi RP, Margolick JB, Jacobson LP, Shah KV. Investigation of pre-diagnostic virological markers for progressive multifocal leukoencephalopathy in human immunodeficiency virus-infected patients. J Med Virol. Jul 2009;81(7):1140-50. [Medline].

  7. Mofenson LM, Brady MT, Danner SP, Dominguez KL, Hazra R, Handelsman E, et al. Guidelines for the Prevention and Treatment of Opportunistic Infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recomm Rep. Sep 4 2009;58:1-166. [Medline].

  8. Hernández B, Dronda F, Moreno S. Treatment options for AIDS patients with progressive multifocal leukoencephalopathy. Expert Opin Pharmacother. Feb 2009;10(3):403-16. [Medline].

  9. Tan CS, Dezube BJ, Bhargava P, Autissier P, Wüthrich C, Miller J, et al. Detection of JC virus DNA and proteins in the bone marrow of HIV-positive and HIV-negative patients: implications for viral latency and neurotropic transformation. J Infect Dis. Mar 15 2009;199(6):881-8. [Medline].

  10. Focosi D, Kast RE, Maggi F, Ceccherini-Nelli L, Petrini M. JC virus DNA in healthy brain tissue: a challenge for progressive multifocal leukoencephalopathy diagnosis. Ann Neurol. Feb 2009;65(2):230; author reply 230-31. [Medline].

  11. Thurnher MM, Post MJ, Rieger A, et al. Initial and follow-up MR imaging findings in AIDS-related progressive multifocal leukoencephalopathy treated with highly active antiretroviral therapy. AJNR Am J Neuroradiol. 2001;22(5):977-84. [Medline].

  12. Port JD, Miseljic S, Lee RR, et al. Progressive multifocal leukoencephalopathy demonstrating contrast enhancement on MRI and uptake of thallium-201: a case report. Neuroradiology. 1999;41 (12):895-898. [Medline].

  13. Iranzo A, Moreno A, Pujol J, et al. Proton magnetic resonance spectroscopy pattern of progressive multifocal leukoencephalopathy in AIDS. J Neurol Neurosurg Psychiatry. Apr 1999;66(4):520-3. [Medline].

  14. Ohta K, Obara K, Sakauchi M, et al. Lesion extension detected by diffusion-weighted magnetic resonance imaging in progressive multifocal leukoencephalopathy. J Neurol. 2001;248(9):809-811. [Medline].

  15. Simone IL, Federico F, Tortorella C, et al. Localized 1H-MR spectroscopy for metabolic characterisation of diffuse and focal brain lesions in patients infected with HIV. J Neurol Neurosurg Psychiatry. Apr 1998;64(4):516-23. [Medline].

  16. Sakai M, Inoue Y, Aoki S, Sirasaka T, Uehira T, Takahama S, et al. Follow-up magnetic resonance imaging findings in patients with progressive multifocal leukoencephalopathy: evaluation of long-term survivors under highly active antiretroviral therapy. Jpn J Radiol. Feb 2009;27(2):69-77. [Medline].

  17. Post MJ, Yiannoutsos C, Simpson D, et al. Progressive multifocal leukoencephalopathy in AIDS: are there any MR findings useful to patient management and predictive of patient survival? AIDS Clinical Trials Group, 243 Team. AJNR Am J Neuroradiol. 1999;20(10):1896-1906. [Medline].

  18. Berger JR, Levy RM, Flomenhoft D, Dobbs M. Predictive factors for prolonged survival in acquired immunodeficiency syndrome-associated progressive multifocal leukoencephalopathy. Ann Neurol. Sep 1998;44(3):341-9. [Medline].

  19. Collazos J, Mayo J, Martínez E, et al. Contrast-enhancing progressive multifocal leukoencephalopathy as an immune reconstitution event in AIDS patients. AIDS. Jul 30 1999;13(11):1426-8. [Medline].

  20. Ernst T, Chang L, Witt M, et al. Progressive multifocal leukoencephalopathy and human immunodeficiency virus-associated white matter lesions in AIDS: magnetization transfer MR imaging. Radiology. Feb 1999;210(2):539-43. [Medline].

  21. O''Malley JP, Ziessman HA, Kumar PN, et al. Diagnosis of intracranial lymphoma in patients with AIDS: value of 201TI single-photon emission computed tomography. AJR Am J Roentgenol. Aug 1994;163(2):417-21. [Medline].

  22. Nelson PK, Masters LT, Zagzag D, et al. Angiographic abnormalities in progressive multifocal leukoencephalopathy: an explanation based on neuropathologic findings. AJNR Am J Neuroradiol. Mar 1999;20(3):487-94. [Medline].

  23. Berger JR, Major EO. Progressive multifocal leukoencephalopathy. Semin Neurol. 1999;19(2):193-200. [Medline].

  24. Berger JR, Pall L, Lanska D, Whiteman M. Progressive multifocal leukoencephalopathy in patients with HIV infection. J Neurovirol. 1998;4(1):59-68. [Medline].

  25. Chang L, Ernst T, Tornatore C, et al. Metabolite abnormalities in progressive multifocal leukoencephalopathy by proton magnetic resonance spectroscopy. Neurology. Apr 1997;48(4):836-45. [Medline].

  26. Dworkin MS. A review of progressive multifocal leukoencephalopathy in persons with and without AIDS. Curr Clin Top Infect Dis. 2002;22:181-95. [Medline].

  27. Kastrup O, Maschke M, Diener HC, et al. Progressive multifocal leukoencephalopathy limited to the brain stem. Neuroradiology. Mar 2002;44(3):227-9. [Medline].

  28. Kotecha N, George MJ, Smith TW, et al. Enhancing progressive multifocal leukoencephalopathy: an indicator of improved immune status?. Am J Med. Dec 1998;105(6):541-3. [Medline].

  29. Mader I, Herrlinger U, Klose U, et al. Progressive multifocal leukoencephalopathy: analysis of lesion development with diffusion-weighted MRI. Neuroradiology. Oct 2003;45(10):717-21. [Medline].

  30. Mayo J, Collazos J, Martínez E. Progressive multifocal leukoencephalopathy following initiation of highly active antiretroviral therapy. AIDS. Sep 10 1998;12(13):1720-2. [Medline].

  31. Nicoli F, Chave B, Peragut JC, Gastaut JL. Efficacy of cytarabine in progressive multifocal leucoencephalopathy in AIDS. Lancet. 1992;339(8788):306. [Medline].

  32. Portegies P, Algra PR, Hollak CE, et al. Response to cytarabine in progressive multifocal leucoencephalopathy in AIDS. Lancet. 1991;337(8742):680-681. [Medline].

  33. Sadler M, Nelson MR. Progressive multifocal leukoencephalopathy in HIV. Int J STD AIDS. 1997;8(6):351-357. [Medline].

Keywords

progressive multifocal leukodystrophy, PML, progressive multifocal leukoencephalopathy, acquired immune deficiency, AIDS, multifocal demyelination, JC virus,

Contributor Information and Disclosures

Author

Manohar Aribandi, MD, Academic Chief, Section of Neuroradiology, Department of Radiology, Geisinger Medical Center
Manohar Aribandi, MD is a member of the following medical societies: American Society of Neuroradiology
Disclosure: Nothing to disclose.

Coauthor(s)

Anil Kumar Aribandi, MBBS, MD, MRCP, Specialist Registrar, Department of Hematology, Manchester Royal Infirmary, UK
Disclosure: Nothing to disclose.

Medical Editor

Mahesh R Patel, MD, Chief, MRI, Department of Diagnostic Imaging, Santa Clara Valley Medial Center
Mahesh R Patel, MD is a member of the following medical societies: American Roentgen Ray Society, American Society of Neuroradiology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Robert L DeLaPaz, MD, Director, Professor, Department of Radiology, Division of Neuroradiology, Columbia University
Robert L DeLaPaz, MD is a member of the following medical societies: American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

L Gill Naul, MD, Professor and Head, Department of Radiology, Texas A&M University College of Medicine; Chair, Department of Radiology, Chief, Section of Magnetic Resonance Imaging, Scott and White Memorial Hospital and Clinic
L Gill Naul, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Radiological Society of North America, and Texas Medical Association
Disclosure: Nothing to disclose.

 
 
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