tommyk
10-05-2006, 11:59 PM
Hy 2431 A rather difficult Neuroanatomy question in my opinion, I can’t believe how tough they are getting…
A patient named Hurricane Katrina with AIDS and a CD4 cell count of 10/mm3 comes to medical attention because of the recent onset of motor and sensory neurologic deficits and mental status changes (This is a natural disaster of a lab finding). CSF examination reveals mild lymphocytosis. Neuroimaging studies show multiple ill-defined areas of T2 changes, interpreted as evidence of demyelination. These areas are located in the white matter of both cerebral hemispheres and cerebellum. What is da’ diagnosis? (Guess first, no cheating)…(Also, know all the below diseases cold on AIDS, it is big time for NBME now) Plus, specifically, beside HIV, what OTHER virus is involved if any? In the answer choices, you must KNOW WHERE EACH VIRUS has a tendency to attack in the brain!
1-CMV encephalitis
2-Toxoplasmosis
3-PCP
4-AIDS dementia
5-Progressive multifocal leukoencephalopathy (PML)
6-Multiple sclerosis
ans) Pick #5. The history of severe HIV-related immune compromise and evidence of destruction of myelin at multiple sites in the CNS points to a diagnosis of progressive multifocal leukoencephalopathy (PML). PML is caused by JC virus, a papovavirus that produces asymptomatic infections in immunocompetent hosts. Oligodendrocytes in active lesions contain characteristic intranuclear inclusions. Usually, biopsy of the lesions is not necessary, as a presumptive diagnosis of PML can be made on clinical grounds. PML is also seen in patients with lymphomas, or those receiving organ transplants. In AIDS-dementia complex, there is no focal brain lesion. Sometimes, diffuse, but usually mild, cerebral atrophy can be identified by MRI. Patients present with progressive dementia, often associated with incontinence and disorientation. Cerebral toxoplasmosis typically manifests with a round, well-circumscribed lesion that shows a peripheral rim of contrast enhancement. Please take my hint and look up a picture of PML as a CT scan. CMV encephalitis has a predilection for the periventricular gray matter and ependyma, as well as the retina. Multiple sclerosis (MS) does not develop in the context of immune impairment. Demyelinating plaques of MS are typically well-demarcated and most commonly located in the periventricular regions.
A patient named Hurricane Katrina with AIDS and a CD4 cell count of 10/mm3 comes to medical attention because of the recent onset of motor and sensory neurologic deficits and mental status changes (This is a natural disaster of a lab finding). CSF examination reveals mild lymphocytosis. Neuroimaging studies show multiple ill-defined areas of T2 changes, interpreted as evidence of demyelination. These areas are located in the white matter of both cerebral hemispheres and cerebellum. What is da’ diagnosis? (Guess first, no cheating)…(Also, know all the below diseases cold on AIDS, it is big time for NBME now) Plus, specifically, beside HIV, what OTHER virus is involved if any? In the answer choices, you must KNOW WHERE EACH VIRUS has a tendency to attack in the brain!
1-CMV encephalitis
2-Toxoplasmosis
3-PCP
4-AIDS dementia
5-Progressive multifocal leukoencephalopathy (PML)
6-Multiple sclerosis
ans) Pick #5. The history of severe HIV-related immune compromise and evidence of destruction of myelin at multiple sites in the CNS points to a diagnosis of progressive multifocal leukoencephalopathy (PML). PML is caused by JC virus, a papovavirus that produces asymptomatic infections in immunocompetent hosts. Oligodendrocytes in active lesions contain characteristic intranuclear inclusions. Usually, biopsy of the lesions is not necessary, as a presumptive diagnosis of PML can be made on clinical grounds. PML is also seen in patients with lymphomas, or those receiving organ transplants. In AIDS-dementia complex, there is no focal brain lesion. Sometimes, diffuse, but usually mild, cerebral atrophy can be identified by MRI. Patients present with progressive dementia, often associated with incontinence and disorientation. Cerebral toxoplasmosis typically manifests with a round, well-circumscribed lesion that shows a peripheral rim of contrast enhancement. Please take my hint and look up a picture of PML as a CT scan. CMV encephalitis has a predilection for the periventricular gray matter and ependyma, as well as the retina. Multiple sclerosis (MS) does not develop in the context of immune impairment. Demyelinating plaques of MS are typically well-demarcated and most commonly located in the periventricular regions.