Akinetic Mutism Caused by HIV-associated Progressive Multifocal Leukoencephalopathy was Successfully Treated with Mefloquine: A Serial Multimodal MRI Study

  • Naito Kasane
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan Department of Neurology, Hiroshima City Hospital, Japan
  • Ueno Hiroki
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
  • Sekine Mayu
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
  • Kanemitsu Munekazu
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
  • Ohshita Tomohiko
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan Department of Neurology, Suiseikai Kajikawa Hospital, Japan
  • Nakamura Takeshi
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
  • Yamawaki Takemori
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
  • Matsumoto Masayasu
    Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan

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Abstract

We report a case of a patient with highly active anti-retroviral therapy-resistant human immunodeficiency virus (HIV)-associated progressive multifocal leukoencephalopathy (PML). The patient showed an improvement in imaging findings and clinical symptoms after mefloquine was introduced as an additional treatment. Serial assessment of white matter lesions was conducted by proton magnetic resonance spectroscopy (1H-MRS) and diffusion-weighted imaging (DWI). As the clinical symptoms improved, the N-acetylaspartate/creatine ratio increased, the choline/creatine ratio decreased, and the elevated ADC value decreased. These concomitant changes suggested that 1H-MRS and DWI were useful for the assessment of the therapeutic effect on PML.<br>

Journal

  • Internal Medicine

    Internal Medicine 51 (2), 205-209, 2012

    The Japanese Society of Internal Medicine

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