PMC3413346_01
Cranial T1-weighted magnetic resonance imaging at the end of September 2010 revealed nodular contrast enhancement with subcortical diffuse restriction in the right parieto-occipital region which is not typical for multiple sclerosis.. Note: Also, the left side already showed a small subcortical lesion with diffusion restriction.
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After intravenous treatment with methylprednisolone 1000 mg per day for 5 days, her clinical neurological symptoms partly recovered, but an ophthalmological deficit characterized by visual loss and visual field defects was unresponsive to this treatment (see Figure 1). Although ataxia and weakness on the right side increased, a lumbar puncture was negative for John Cunningham virus (by polymerase chain reaction [PCR]) at that time. Cranial T1-weighted magnetic resonance imaging revealed a nodular contrast enhancement with subcortical diffuse restriction in the right parieto-occipital region, consistent with the diagnosis of PML, in addition to white matter lesions typical of multiple sclerosis (Figure 1).
Visual field testing in October 2010 demonstrated a homonymous hemianopia to the left (Octopus 101, 30 , Haag Streit, Germany).. Note: Follow-up visual field testing during natalizumab cessation and PML treatment did not show any change in these findings.
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The visual field (Octopus 101, 30 , Haag Streit, Germany) displayed a homonymous hemianopia on the left side (Figure 2).