new_n_lost
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A 45-year-old woman is undergoing chemotherapy for chronic lymphocytic leukemia. She begins to develop progressive neurological impairment, including weakness of the right leg and double vision. Imaging demonstrates extensive scattered areas of asymmetric demyelination involving both the cerebrum and cerebellum. The patient becomes more unresponsive and succumbs to a secondary unrelated infection. At autopsy, microscopic examination of the brain demonstrates viral inclusion bodies within oligodendrocytes and bizarre giant astrocytes. Which of the following is the most likely diagnosis?
(A) Acute disseminated encephalomyelitis
(B) Central pontine myelinolysis
(C) Multiple sclerosis
(D) Progressive multifocal leukoencephalopathy
(E) Subacute sclerosing panencephalitis
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| me007
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d.
progressive multifocal leukoencephalopathy
slow virus encephalitis - papovavirus
usually in AIDS.
intranuclear inclusions in oligodendrocytes.
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| Ancylostoma
Forum Guru
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I would go with D,
Jc virus(papova) IC and AIDS,
You can use elimination to get this answer as well
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| new_n_lost
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Yes its D
The etiologic agent of Progressive Multifocal Leukoencephalopathy is JC virus. Most people have evidence of exposure to the virus, however neurologic defects are predominantly seen in the immunosuppressed or immunocompromised. As the name implies, the disease is multifocal and progressive, often leading to coma. Histology demonstrates the characteristic viral inclusion bodies.
Acute disseminated encephalomyelitis (ADEM) typically occurs after a viral infection or an immunization. The symptoms include headache and lethargy. The findings are nonfocal.
Central pontine myelinolysis is caused by osmotically mediated damage secondary to rapid correction of electrolyte abnormalities.
Multiple sclerosis presents with similar focal neurologic symptoms that cannot be attributed to a single tract or area of the brain. The course would not be so rapid and the mechanism is autoimmune in nature.
Subacute Sclerosing Panencephalitis can occur in the young often years after a measles infection. There are areas of demyelination and neurofibrillary tangles.
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| darkhorse
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nice q
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