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 ( 1 H-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 1 H-MRS and DWI were useful for the assessment of the therapeutic effect on PML.

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A 27-year-old Japanese man ingested methanol. He presented with reduced vision and lost consciousness after 2 days. He became comatose and developed metabolic acidosis, but improved and was discharged after 18 days. A brain magnetic resonance imaging-fluid attenuation inversion recovery sequence showed lesions in the putamen, caudate nucleus and subcortical white matter of both cerebral hemispheres. Magnetic resonance spectroscopy showed a low N-acetylaspartate level, and high choline and lactic acid levels in the right putamen lesion, indicating that recovery coincided with symptom improvement. These magnetic resonance spectroscopy features might reflect the neuronal mitochondrial dysfunction and anaerobic glycolysis caused by the effect of formic acid, a metabolite of methanol.

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