Progressive Multifocal Leukoencephalopathy: Recent Advances and a Neuro-Ophthalmological Review. [Review]

MedStar author(s):
Citation: Journal of Neuro-Ophthalmology. 35(3):296-305, 2015 Sep.PMID: 26132966Institution: MedStar Washington Hospital Center | MedStar Washington Hospital CenterDepartment: Ophthalmology | RadiologyForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal Article | ReviewSubject headings: *Leukoencephalopathy, Progressive Multifocal/di [Diagnosis] | *Leukoencephalopathy, Progressive Multifocal/th [Therapy] | *Neurology/mt [Methods] | *Ophthalmology/mt [Methods] | Adult | Brain | Female | Humans | Leukoencephalopathy, Progressive Multifocal/ep [Epidemiology] | Magnetic Resonance Imaging | Male | Middle Aged | Visual Pathways/pa [Pathology]Year: 2015Local holdings: Available online from MWHC library: 2001 - present, Available in print through MWHC library: 1998 - 2006ISSN:
  • 1070-8022
Name of journal: Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology SocietyAbstract: BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a severe often fatal opportunistic infection of the central nervous system caused by reactivation of a ubiquitous polyoma virus, JC virus. Although typically characterized by multifocal asymmetric subcortical white matter lesions, it may be monofocal and affect the cortical gray matter. Among the broad spectrum of clinical manifestations that occurs with PML, visual complaints are common.CONCLUSIONS: Visual complaints occur in patients with PML and are often the presenting sign. Awareness of this condition is helpful in avoiding unnecessary delays in the diagnosis of PML and management of the underlying condition. Recent guidelines have established criteria for diagnosis of PML in the high-risk patient population and strategies to mitigate the risk in these populations.EVIDENCE ACQUISITION: Combination of representative personally observed cases of PML and comprehensive review of case series of PML from 1958 through 2014.RESULTS: Neuro-ophthalmic signs and symptoms were reported in approximately 20%-50% of patients with PML and can be the presenting manifestation in half of these. A majority of these presentations occur from damage to cerebral visual pathways resulting in visual field defects, cortical blindness, and other disorders of visual association. Given the decreased frequency of infratentorial and cerebellar involvement, ocular motility disorders are less common.All authors: Bachman DM, Berger JR, Kedar S, Mark AS, Sudhakar PFiscal year: FY2016Digital Object Identifier: Date added to catalog: 2016-07-15
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 26132966 Available 26132966

Available online from MWHC library: 2001 - present, Available in print through MWHC library: 1998 - 2006

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a severe often fatal opportunistic infection of the central nervous system caused by reactivation of a ubiquitous polyoma virus, JC virus. Although typically characterized by multifocal asymmetric subcortical white matter lesions, it may be monofocal and affect the cortical gray matter. Among the broad spectrum of clinical manifestations that occurs with PML, visual complaints are common.

CONCLUSIONS: Visual complaints occur in patients with PML and are often the presenting sign. Awareness of this condition is helpful in avoiding unnecessary delays in the diagnosis of PML and management of the underlying condition. Recent guidelines have established criteria for diagnosis of PML in the high-risk patient population and strategies to mitigate the risk in these populations.

EVIDENCE ACQUISITION: Combination of representative personally observed cases of PML and comprehensive review of case series of PML from 1958 through 2014.

RESULTS: Neuro-ophthalmic signs and symptoms were reported in approximately 20%-50% of patients with PML and can be the presenting manifestation in half of these. A majority of these presentations occur from damage to cerebral visual pathways resulting in visual field defects, cortical blindness, and other disorders of visual association. Given the decreased frequency of infratentorial and cerebellar involvement, ocular motility disorders are less common.

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