new_n_lost
Politically InCorrect
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Posts: 6,086
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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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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| epica
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D ( she has lymphoma, JC polyoma virus virus)
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| indidoc1
Forum Guru
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yup.. D
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"Whether you think you can or whether you think you can't, you're right!" ~ Henry Ford
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| epica
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What is your ans?
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| new_n_lost
Politically InCorrect
Topics: 653
Posts: 6,086
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Choice A: Acute disseminated encephalomyelitis (ADEM) typically occurs after a viral infection or an immunization. The symptoms include headache and lethargy. The findings are nonfocal. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
Choice B: Central pontine myelinolysis is caused by osmotically mediated damage secondary to rapid correction of electrolyte abnormalities.
Choice C: 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.
Choice D: CORRECT: 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.
Choice E: Although not so common any more, subacute sclerosing panencephalitis can occur in the young often years after a measles infection. There are areas of demyelination and neurofibrillary tangles.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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