Progressive multifocal leukoencephalopathy: A review

Abstract

Progressive Multifocal Leukoencephalopathy is a demyelinating disease of the Central Nervous System characterized by widespread lesions due to infection of oligodendrocytes by JC (John Cunningham) virus. Neurological manifestations of JCV induced tissue damage include the classic triad of presenting symptoms of PML. These are visual, motor, and cognitive impairments. In 40% of the initial symptoms, Hemianopsia or the loss of vision in the bisection of the visual field is the most common. In greater than 50% of the cases, severe muscle weakness progressing into hemiparesis or hemiplegia is present. The diagnosis of PML is most appropriately done by brain imaging technique. A classic triad of demyelination, bizarre astrocytes, and oligodendroglial nuclear inclusions include the histopathology of PML. Both serum and CSF should be examined for antibodies against JCV before going for a Brain biopsy. All treatments are exploratory in progressive multifocal Leukoencephalopathy (PML). In PML patients with undetectable plasma HIV, Intensive treatment with 4 classes of antiretroviral drugs, including enfuvirtide, has been reported as delivering a possible survival benefit. Treatment guidelines consider the use of corticosteroids justified in this setting. Further approaches to the isolation of virus and the immunization against the virus may arrest the progression of PML and its deadly complications.