Cytomegalovirus encephalitis radiographically mimicking lateral medullary stroke

Abstract

Cytomegalovirus (CMV) is a double-stranded DNA virus from the herpes virus family. Disseminated or focal end-organ disease typically occurs in immunocompromised individuals, often in the setting of advanced HIV or organ transplantation. Neurologic manifestations include focal encephalitis, meningitis, ventriculoencephalitis, and polyradiculitis. After the advent of highly active antiretroviral therapy (HAART), the incidence of CMV disease has decreased by as much as 80%. 1 This decrease largely predates the widespread adoption of MRI into routine patient care. As a result, our understanding of CMV and the spectrum in which it radiographically manifests is limited. 2 We report a case of CMV ventriculoencephalitis and myelitis radiographically mimicking lateral medullary stroke in a patient with advanced HIV. Case reportA 50-year-old HIV-positive man was admitted for a 4-day history of diarrhea. He was referred to neurology for left-sided sensorimotor deficits, and an MRI reported as demonstrating a lateral medullary infarct (figure 1A). He was diagnosed with HIV 14 years ago and was well controlled on HAART up until 4 years ago, at which time he stopped all treatment because of a refusal to accept his diagnosis. His CD4 + count reached a nadir of 10 cells/mm 3 , and the peak viral load was 263,132 copies/mL. Seven months before presentation, he was admitted with disseminated CMV infection manifesting as CMV colitis and retinitis. At that time, he was treated with IV ganciclovir and discharged on prolonged suppressive therapy with oral valganciclovir. Collateral history revealed that he began having slowly progressive left hemibody sensorimotor symptoms 11 months before his current admission.

The dynamic changes of recurrent Immune reconstitution inflammatory syndrome of an AIDS patient with cytomegalovirus encephalitis and pulmonary tuberculosis：a case report

“…Anderson et al [7] reported typical MRI of AIDS-associated CMV encephalitis revealed equal to slightly low signal on T1WI, low signal on T1WI, high signal on T2WI and FLAIR, slightly high signal on DWI, and low signal on ADC. Restricted diffusion MRI lesions is one of the speci c manifestations of CMV encephalitis [8,9] and may exist for a long time [10] . Only a few of them have been reported to have enhanced contrast.…”