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Progressive multifocal leucoencephalopathy in AIDS camouflaged with catatonia: A wolf in sheep's clothing.

Kumar P, Jain MK - Indian J Psychiatry (2006)

Bottom Line: Progressive multifocal leucoencephalopathy (PML) may pose a clinical and diagnostic dilemma.The patient may remain in a protracted psychotic state with negative symptoms, without overt features of dementia.The condition blends with catatonia, and eventually with akinetic mutism in a patient of AIDS in the absence of clinical evidence of an immunocompromised state.

View Article: PubMed Central - PubMed

Affiliation: Associate Professor, Department of Medicine, S.S. Medical College and Associated S.G.M. Hospital, Rewa, Madhya Pradesh.

ABSTRACT
Progressive multifocal leucoencephalopathy (PML) may pose a clinical and diagnostic dilemma. The patient may remain in a protracted psychotic state with negative symptoms, without overt features of dementia. The condition blends with catatonia, and eventually with akinetic mutism in a patient of AIDS in the absence of clinical evidence of an immunocompromised state. The present case report highlights the need for an in-depth clinical, biochemical and MRI assessment of patients with catatonia and akinetic mutism. Stupor of an 'akinetic mutism' pattern seems an important indication for HIV screening, particularly in high-risk patients.

No MeSH data available.


Related in: MedlinePlus

CT scan brain showing a non-enhancing hypodense lesion in the left frontal cortex with sulci prominent in relation to the age.
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Figure 0001: CT scan brain showing a non-enhancing hypodense lesion in the left frontal cortex with sulci prominent in relation to the age.

Mentions: Higher function examination revealed an extreme degree of hypokinesia, mutism and catalepsy for more than 30 seconds. He looked conscious, vigilant with positive eye-tracking movements, and loss of apparent condition-avoidance response. Orientation, attention, concentration, memory and judgement could not be commented upon due to mutism. His affect was blunt without weeping or laughing spells (no pseudobulbar pattern). Cerebellar signs could not be tested; mild motor ataxia was present. There was no sensory–motor deficit but bladder and bowel incontinence was present. A syndromic diagnosis of catatonia was made. The patient was subjected to a battery of investigations. Routine blood and urine examination, hepatic and renal function tests were within normal limits except mild iron deficiency anaemia; serum B12 and HbAIC levels were within the normal range. The optic fundus was normal. CSF pressure and biochemical parameters were normal and the VDRL test was negative. X-ray chest and USG abdomen were normal. CT scan revealed a single non-enhancing hypodense lesion in the left frontal cortex and mild cerebral atrophy for his age (Fig 1).


Progressive multifocal leucoencephalopathy in AIDS camouflaged with catatonia: A wolf in sheep's clothing.

Kumar P, Jain MK - Indian J Psychiatry (2006)

CT scan brain showing a non-enhancing hypodense lesion in the left frontal cortex with sulci prominent in relation to the age.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2913650&req=5

Figure 0001: CT scan brain showing a non-enhancing hypodense lesion in the left frontal cortex with sulci prominent in relation to the age.
Mentions: Higher function examination revealed an extreme degree of hypokinesia, mutism and catalepsy for more than 30 seconds. He looked conscious, vigilant with positive eye-tracking movements, and loss of apparent condition-avoidance response. Orientation, attention, concentration, memory and judgement could not be commented upon due to mutism. His affect was blunt without weeping or laughing spells (no pseudobulbar pattern). Cerebellar signs could not be tested; mild motor ataxia was present. There was no sensory–motor deficit but bladder and bowel incontinence was present. A syndromic diagnosis of catatonia was made. The patient was subjected to a battery of investigations. Routine blood and urine examination, hepatic and renal function tests were within normal limits except mild iron deficiency anaemia; serum B12 and HbAIC levels were within the normal range. The optic fundus was normal. CSF pressure and biochemical parameters were normal and the VDRL test was negative. X-ray chest and USG abdomen were normal. CT scan revealed a single non-enhancing hypodense lesion in the left frontal cortex and mild cerebral atrophy for his age (Fig 1).

Bottom Line: Progressive multifocal leucoencephalopathy (PML) may pose a clinical and diagnostic dilemma.The patient may remain in a protracted psychotic state with negative symptoms, without overt features of dementia.The condition blends with catatonia, and eventually with akinetic mutism in a patient of AIDS in the absence of clinical evidence of an immunocompromised state.

View Article: PubMed Central - PubMed

Affiliation: Associate Professor, Department of Medicine, S.S. Medical College and Associated S.G.M. Hospital, Rewa, Madhya Pradesh.

ABSTRACT
Progressive multifocal leucoencephalopathy (PML) may pose a clinical and diagnostic dilemma. The patient may remain in a protracted psychotic state with negative symptoms, without overt features of dementia. The condition blends with catatonia, and eventually with akinetic mutism in a patient of AIDS in the absence of clinical evidence of an immunocompromised state. The present case report highlights the need for an in-depth clinical, biochemical and MRI assessment of patients with catatonia and akinetic mutism. Stupor of an 'akinetic mutism' pattern seems an important indication for HIV screening, particularly in high-risk patients.

No MeSH data available.


Related in: MedlinePlus