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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

T1W axial image at the level of the centrum semi-ovale. Multiple focal hypointense lesions are seen bilaterally in the subcortical white matter of the frontal lobe causing widening of the overlying gyri on the left side (arrow).
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Figure 0002: T1W axial image at the level of the centrum semi-ovale. Multiple focal hypointense lesions are seen bilaterally in the subcortical white matter of the frontal lobe causing widening of the overlying gyri on the left side (arrow).

Mentions: After 7 days of hospitalization, the patient revealed positive grasp, rooting and glabellar tap reflexes, and right hemiparesis (grade III). At that point, considering the focal cerebral damage, he was categorized as a case of akinetic mutism. The patient was found to be positive for HIV-1 and -2, which was confirmed by the Western blot test. The total leucocyte count was 4990 cells/cmm, lymphocytes were 16%, the absolute lymphocyte count was 800 cells/cmm. The absolute CD3+ T lymphocyte count was 528 cells/cmm. The absolute CD4+ T helper cell count was 339 cells/cmm (normal range 337–1690 cells/cmm). Analysis was done using the flowcytometry method. MRI, done after 5 days of CT scan, revealed multiple, confluent, non-enhancing, discrete, asymmetric, subcortical white matter lesions, maximum in the frontoparieto-occipital and cerebellar regions without mass effect (Figs 2–5). Ante-mortem brain biopsy was not feasible.


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

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

T1W axial image at the level of the centrum semi-ovale. Multiple focal hypointense lesions are seen bilaterally in the subcortical white matter of the frontal lobe causing widening of the overlying gyri on the left side (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: T1W axial image at the level of the centrum semi-ovale. Multiple focal hypointense lesions are seen bilaterally in the subcortical white matter of the frontal lobe causing widening of the overlying gyri on the left side (arrow).
Mentions: After 7 days of hospitalization, the patient revealed positive grasp, rooting and glabellar tap reflexes, and right hemiparesis (grade III). At that point, considering the focal cerebral damage, he was categorized as a case of akinetic mutism. The patient was found to be positive for HIV-1 and -2, which was confirmed by the Western blot test. The total leucocyte count was 4990 cells/cmm, lymphocytes were 16%, the absolute lymphocyte count was 800 cells/cmm. The absolute CD3+ T lymphocyte count was 528 cells/cmm. The absolute CD4+ T helper cell count was 339 cells/cmm (normal range 337–1690 cells/cmm). Analysis was done using the flowcytometry method. MRI, done after 5 days of CT scan, revealed multiple, confluent, non-enhancing, discrete, asymmetric, subcortical white matter lesions, maximum in the frontoparieto-occipital and cerebellar regions without mass effect (Figs 2–5). Ante-mortem brain biopsy was not feasible.

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