Progressive multifocal leukoencephalopathy in patients with hiv infection: Lack of impact of early diagnosis by stereotactic brain biopsy

Dean Karahalios, Robert Breit*, Mauro C.Dal Canto, Robert M. Levy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Summary: Thirteen patients with HIV-related progressive multifocal leukoencephalopathy (PML), representing an institutional incidence of 4.2%, are reported. All cases were diagnosed by image guided stereotactic brain biopsy shortly after their presentation for neurologic complaints. All patients were males; risk factors included homosexual or bisexual activity or intravenous drug use. At the time of presentation with PML, the mean T4 count was 85 (range 9–240 cells/mm3). The most common neurologic symptoms were cognitive dysfunction and aphasia, whereas gait abnormalities and disordered cognition were the most common neurologic signs. Cerebrospinal fluid analysis was helpful only to rule out other causes of CNS disease. Magnetic resonance imaging, more sensitive than computed tomography (CT) scanning, typically revealed multiple areas of increased intensity on T2 weighted images although unifocal disease was seen in 23% of patients. Despite early stereotactic biopsy and aggressive symptomatic therapy, survival of these patients was poor with a mean of 2.6 months after the onset of neurological symptoms and 2.0 months after biopsy.

Original languageEnglish (US)
Pages (from-to)1030-1038
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume5
Issue number10
StatePublished - Oct 1992

Keywords

  • HIV infection
  • Progressive multifocal leukoencephalopathy (PML)
  • Stereotactic brain biopsy

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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