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Progressive Multifocal Leukoencephalopathy Associated with Human Immunodeficiency Virus Infection: A Review of the Literature with a Report of Sixteen Cases

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This study was presented in part at the 38th Annual Meeting of the American Academy of Neurology on 30 April 1986 in New Orleans, Louisiana.

▸Requests for reprints should be addressed to Joseph R. Berger, M.D.; University of Miami School of Medicine, Department of Neurology (D4-5), P. O. Box 016960; Miami, FL 33101.

Miami, Florida

©1987 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1987;107(1):78-87. doi:10.7326/0003-4819-107-1-78
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Progressive multifocal leukoencephalopathy, a common complication of infections with human immunodeficiency virus (HIV), occurs in as many as 3.8% of patients with the acquired immunodeficiency syndrome (AIDS). We report 16 cases and review 12 previously reported cases of progressive multifocal leukoencephalopathy associated with HIV infection. This illness was the presenting manifestation of HIV infection in 8 cases. Limb weakness, gait abnormalities, visual loss, and altered mental status were the commonest initial complaints. Computed tomography of the brain frequently showed hypodense, nonenhancing white matter lesions. Magnetic resonance imaging was more sensitive than computed tomography in detecting lesions. Cerebrospinal fluid analysis and electroencephalography were nondiagnostic. Impaired cell-mediated immunity was typically noted, even in the absence of other immunodeficiency-associated illnesses. Death occurred within 10 days to 18 months of the onset of symptoms in 22 patients. However, 4 patients remain alive at 3 to 23 months; of these 4, 2 have had significant improvement without treatment. Various therapies were unsuccessful.





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