Brainstem progressive multifocal leukoencephalopathy

Gautier Breville*, Igor J. Koralnik, Patrice H. Lalive

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background and purpose: Progressive multifocal leukoencephalopathy (PML) is a severe infection caused by the polyomavirus JC that develops in the central nervous system (CNS) of immunosuppressed patients. The infection frequently starts in the brain hemispheres and can spread into other CNS regions such as the brainstem. Initial isolated PML brainstem lesions are exceptional. We aimed to describe the challenging diagnosis of PML with isolated brainstem lesions at the time of disease onset. Methods: We describe a case of PML starting with an isolated brainstem lesion and reviewed clinical, radiological, and biological features of all the reported cases of isolated brainstem PML. Results: Isolated brainstem PML at disease onset is extremely rare. In addition to our case, only nine PML cases presenting with strictly isolated radioanatomical brainstem location at the time of disease onset were retrieved through the literature. All patients share similar brain magnetic resonance imaging features, without contrast enhancement. Eight patients presented with initial clinical worsening, but full recovery occurred in three patients, partial recovery in two, and death in three. Even if prognosis is reserved because of the surrounding vital structures in the brainstem, clinical recovery may occur. Conclusions: This case report and literature review emphasize that isolated brainstem lesion is an atypical presentation of PML at disease onset.

Original languageEnglish (US)
Pages (from-to)1016-1021
Number of pages6
JournalEuropean Journal of Neurology
Volume28
Issue number3
DOIs
StatePublished - Mar 2021

Funding

This study was supported in part by National Institutes of Health grant R01 NS047029 to I.J.K. None of the funders had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Keywords

  • JC virus
  • brainstem
  • progressive multifocal leukoencephalopathy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Fingerprint

Dive into the research topics of 'Brainstem progressive multifocal leukoencephalopathy'. Together they form a unique fingerprint.

Cite this