Progressive multifocal leukoencephalopathy and occult advanced glaucoma
clinical-diagnostic challenges in a patient with secondary dementia
DOI:
https://doi.org/10.70313/2718.7446.v18.n4.460Keywords:
pogressive multifocal leukoencephalopathy, dementia, glaucomaAbstract
Objective. Progressive multifocal leukoencephalopathy (PML) is a demyelinating infectious disease that occurs in patients with HIV at the AIDS stage. It is characterized by multifocal lesions in the cerebral white matter that produce neurological and ophthalmological manifestations mimicking a space-occupying lesion without being one. The coexistence of other conditions may complicate the differential diagnosis. We report a case in which an interdisciplinary assessment led to the identification of advanced glaucoma as the main cause of visual loss.
Case Report. A male patient presented with progressive visual acuity loss. During history taking, hindered by marked cognitive and language impairment, he reported a previous hospitalization for altered sensorium, during which he had been diagnosed with PML secondary to HIV infection in the AIDS stage. Comprehensive neurological and ophthalmic evaluations confirmed advanced glaucoma as the underlying ocular disease responsible for the visual decline.
Conclusion. This case highlights the diagnostic and therapeutic challenges that arise when cognitive or language disorders interfere with the doctor–patient relationship. Accurate identification of the visual deficit’s etiology in complex neurological contexts is crucial to prevent misdiagnosis and guide appropriate management.
Downloads
References
1. Tan CS, Koralnik IJ. Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. Lancet Neurol 2010; 9(4): 425-437. doi: 10.1016/S1474-4422(10)70040-5.
2. Snopková S, Štourač P, Fašaneková L, Mihalčin M, Havlíčková K, Svačinka R, Volfová P, Snopek P, Husa P. Progressive multifocal leukoencephalopathy: epidemiology, immune response, clinical differences, treatment. Epidemiol Mikrobiol Imunol 2019; 68(1): 24-31.
3. Schweitzer F, Laurent S, Cortese I, Fink GR, Silling S, Skripuletz T, Metz I, Wattjes MP, Warnke C. Progressive multifocal leukoencephalopathy: pathogenesis, diagnostic tools, and potential biomarkers of response to therapy. Neurology 2023; 101(16): 700-713. doi: 10.1212/WNL.0000000000207622.
4. Danesh-Meyer HV, Moster ML. At the crossroads of glaucoma and neuro-ophthalmology. J Neuroophthalmol 2015; 35 Suppl 1: S1-S3. doi: 10.1097/WNO.0000000000000294.
5. Reynolds GL, Plant G, Epps S, Sebastian R, Bennetto L. Glaucoma: what the neurologist needs to know. Pract Neurol 2024; 24(6): 493-502. doi: 10.1136/pn-2023-003905.
6. Al-Timimi Z, Huang-Lung J, Keay L, Healey P, Yang E, Dunn H. A systematic review of glaucoma diagnosis in prevalence studies and quality of reporting. J Glaucoma 2023; 32(10): 874-884. doi: 10.1097/IJG.0000000000002248.
7. Jin E, Goh CXY, Betzler BK, Heng CP, Ang BCH. Assessing the value of the water drinking test in glaucoma-a systematic review and meta-analysis. Eye (Lond) 2024; 38(14): 2688-2700. doi: 10.1038/s41433-024-03107-z.
8. Pitha I, Du L, Nguyen TD, Quigley H. IOP and glaucoma damage: the essential role of optic nerve head and retinal mechanosensors. Prog Retin Eye Res 2024; 99: 101232. doi: 10.1016/j.preteyeres.2023.101232.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Consejo Argentino de Oftalmología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Con esta licencia no se permite un uso comercial de la obra original, ni la generación de obras derivadas. Las licencias Creative Commons permiten a los autores compartir y liberar sus obras en forma legal y segura.
How to Cite
