Progressive multifocal leukoencephalopathy (PML): investigations

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Progressive multifocal leukoencephalopathy (PML): investigations. These are subcortical white matter lesions. Fully referenced neurology checklist.

Magnetic resonance imaging (MRI) lesion features

  • These are subcortical white matter lesions
  • They are multifocal and asymmetric
  • They are hypointense on T1 sequences
  • They appear as high signal on T2 and FLAIR sequences
  • They are relatively non-enhancing
  • A punctate pattern of lesions is sensitive for Natalizumab PML

Magnetic resonance imaging (MRI) other features

Locked: subscribe to see this section.

Cerebrospinal fluid (CSF)

Locked: subscribe to see this section.

Diagnostic criteria for PML

Locked: subscribe to see this section.

Differential diagnosis from PML-IRIS on MRI

Locked: subscribe to see this section.

Acronyms

Locked: subscribe to see this section.

References

  1. Hunt D, Giovannoni G. Natalizumab-associated progressive multifocal leucoencephalopathy: a practical approach to risk profiling and monitoring. Pract Neurol 2012; 12:25-35.
  2. Clifford DB, DeLuca A, Simpson DM, Arendt G, Giovannoni G, Nath A. Natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: lessons from 28 cases. Lancet Neurol 2010; 9:438-446.
  3. Warnke C, Menge T, Hartung H-P, et al. Natalizumab and progressive multifocal leukoencephalopathy. Arch Neurol 2010; 67:923-930.McGuigan C, Craner M, Guadagno J, et al. Stratification and monitoring of natalizumab-associated progressive multifocal leukoencephalopathy risk: recommendations from an expert group. JNNP 2016; 87:117-125. 
  4. Wattjes MP, Wijburg MT, Vennegoor A, et al; Dutch-Belgian Natalizumab-associated PML study group. MRI characteristics of early PML-IRIS after natalizumab treatment in patients with MS. JNNP 2016; 87:879-884.
  5. Hodel J, Darchis C, Outteryck O, et al. Punctate pattern: a promising imaging marker for the diagnosis of natalizumab-associated PML. Neurology 2016; 86:1516-1523.
  6. And 6 more. Subscribe to see the full list

Related checklists

Loading...