A 39-year-old woman with relapsing-remitting multiple sclerosis treated with natalizumab for 6 months presents with progressive left arm clumsiness, expressive aphasia, and cognitive slowing over 3 weeks. Vital signs: BP 118/76, HR 88, RR 16, Temp 37°C, SpO2 98%. Brain MRI reveals multifocal nonenhancing white matter lesions in the parieto-occipital regions without mass effect or edema. CSF analysis is normal. Which diagnosis best explains these findings?
- A)Central pontine myelinolysis
- B)Multiple sclerosis relapse
- C)Acute disseminated encephalomyelitis
- D)Neuromyelitis optica
- E)Progressive multifocal leukoencephalopathyGABARITO
Explicação
Natalizumab increases the risk of JC virus reactivation, which causes progressive multifocal leukoencephalopathy. The gradual progression, multifocal white matter lesions, and absence of mass effect distinguish it from an acute relapse or abscess. Ver explicação completa e trilha adaptativa →