This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Diagnosing progressive multifocal leukoencephalopathy (PML), particularly when it occurs in the setting of multiple sclerosis (MS), can be challenging. The patient described by Kuhle and colleagues1 in this issue of Neurology® had MS treated with natalizumab and developed left leg weakness and gait impairment, reminiscent of symptoms that she experienced 4 months earlier, although these resolved within 4 weeks of onset and were ascribed to MS relapse. At the time of the recurrence of leg weakness and unsteady gait, she had been on natalizumab for 16 months, though there had been a 4-month interruption in therapy due to an intercurrent infection. MS relapse was again suspected and she was treated with corticosteroids. However, she experienced neurologic progression and a cranial MRI eventually revealed a new contrast-enhancing lesion with a rising titer of CSF antibody to JCV. These findings suggested the presence of inflammatory PML. Repeated CSF quantitative PCR (qPCR) remained negative for JCV DNA even after testing in multiple laboratories using ultrasensitive techniques. Biopsy of the affected brain failed to reveal typical histopathologic findings of PML, specifically, demyelination, bizarre astrocytes, and oligodendroglial nuclear inclusions, and tissue in situ hybridization for JCV was negative. Ultimately, qPCR from the paraffin-embedded tissue was positive for …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
