Non-enhancing demyelination on MRI???

[MDaddict]

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First Aid indicates that JC virus reaction causes PML --> area of demyelination on MRI is non-enhancing?

Where else can this be seen - i.e. what comes to mind in pathophysiology/differential diagnosis when you know that something causes non-enhancing demyelination - I feel like I am missing something very obvious.

 

[seminoma]

First Aid indicates that JC virus reaction causes PML --> area of demyelination on MRI is non-enhancing?

Where else can this be seen - i.e. what comes to mind in pathophysiology/differential diagnosis when you know that something causes non-enhancing demyelination - I feel like I am missing something very obvious.

PML is the only one. Contrast with enhancing that is seen in MS.

 

[Krasmyc]

I got couple of Q wrong based purely on MRI finding. PMl is mostly seen in HIV patients. As such the way i approach CNS lesions in HIV patients is

Ring enhancing VS non-enchancing

Ring enhancing:
CNS primary Lymphoma:
presence of EBV DNA in the CSF + change in M.S + weakly ring-enhancing PERIVENTRICULAR , SOLITARY Mass

Toxoplasmosis: unlikely if pt is receiving TMP-SMX. Also MULTIPLE, ring enchancing, spherical lesions in BASAL GANGLIA.
-i was expecting them to tell us CD count, but they didn't. otherwise CD<100.
-positive toxoplasma serology is common in normal person too so NOT SPECIFIC for toxoplasmosis


Non-enchancing lesion in HIV pt:

AIDS Encephalopathy: cortical & subcortical atrophy & secondary ventricular enlargement
s/s: dementia + depression + movement disorder

PML: JC virus etc

if CD<50--> CMV encephalitis (low yield)

 

[MDaddict]

Thank you Krasmyc and seminoma. I appreciate the thorough reply Krasmyc!