1naresh2naresh
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Types of PML Clinical Presentation Imaging Appearance Histopathology cPML Focal neurologic signs depending on the location of lesions T1 hypointense (to white matter) and T2 hyperintense (to gray matter) lesions in the subcortical U-fiber rather than in periventricular white matter; diffusion restriction at the margin; no enhancement Severe demyelination; swollen oligodendrocytes with enlarged densely basophilic nuclei filled with eosinophilic inclusion bodies; bizarre astrocytes; absent/minimal inflammation iPML iPML in IRIS presents with aggravated cPML symptoms; iPML in the non-IRIS setting has similar or aggravated cPML symptoms Peripheral or rim enhancement with or without mass effect and vasogenic edema Similar to cPML plus marked inflammatory reaction characterized by diffuse or focal perivascular mononuclear cell (mainly CD3) infiltration JCVGCN Cerebellar symptoms including ataxia and dysarthria MR findings are negative in early stage; isolated cerebellar atrophy with T2 hyperintensity in later stage of the disease Isolated infection of the cerebellar granule cell neurons sparing oligodendrocytes JCM Similar to viral meningitis No specific imaging finding CSF positive for JCV DNA JCE Abnormal higher CNS function without focal neurologic deficit Predominant cortical T2 hyperintensity with involvement of white matter in later stage of the disease Extensive infection of the pyramidal cell neurons with meager infection of oligodendrocytes