Siddiqi Zeba, Karoli Ritu, Fatima Jalees, Dey Rahul, Kazmi Khursheed
J Assoc Physicians India. 2014 Aug;62(8):731-3.
A 37 year old man presented with progressive dysarthria for 2 weeks. A week later he developed ataxia and bilateral cerebellar signs including intention tremors, dysmetria and dysdiadokokinesia. During evaluation for aetiology of cerebellar dysarthria, MRI brain revealed asymmetric altered signal intensities in bilateral cerebellar hemispheres and right side of pons suggesting demyelinating lesions. ELISA for Human Immune Deficiency virus-1 was positive. We kept a presumptive diagnosis of Progressive Multifocal Leukoencephalopathy (PML) on the basis of clinico-radiological picture. PML is an under investigated and under diagnosed CNS infection seen in HIV patients with advanced disease. We present an unusual case report where isolated cerebellar involvement occurred as the first AIDS defining event in the absence of appreciable immunodeficiency in a patient with previously undiagnosed HIV infection.
一名37岁男性出现进行性构音障碍2周。一周后，他出现共济失调和双侧小脑体征，包括意向性震颤、辨距不良和轮替运动障碍。在对小脑性构音障碍的病因进行评估期间，脑部MRI显示双侧小脑半球和脑桥右侧信号强度不对称改变，提示脱髓鞘病变。人类免疫缺陷病毒1型酶联免疫吸附测定呈阳性。基于临床影像学表现，我们初步诊断为进行性多灶性白质脑病（PML）。PML是一种在晚期HIV患者中未得到充分研究和诊断的中枢神经系统感染。我们报告了一例不寻常的病例，在一名先前未诊断出HIV感染的患者中，孤立的小脑受累作为首个艾滋病定义事件出现，且无明显免疫缺陷。
