Brief Answer:
Radiology report no concerning for PML

Detailed Answer:
Good afternoon and thank you very much for your question on this network.

So sorry that your wife is having these concerning symptoms which were looked at for possible STROKE. Luckily the MRI showed everything to be negative in that regard. Now, your concern is specifically, whether or not the findings of the MR could represent PML given the fact she is on medications that put her at risk for immune suppression and the fact she is JC virus POSITIVE with high titers.

Perhaps, you are already familiar with this information but PML is a very serious and significant condition that is usually easily seen and not missed on an MRI scan since it is so sensitive for the type of white matter pathology caused by the disorder. However, it is very characteristic in how it looks and I believe it is highly unlikely that a trained neuroradiologist would mistake the presence of PML (even in its earliest forms) for simple FLAIR/T2 hypersensitivities in the periventricular zones which themselves have a pretty typical appearance.

Usually, if a radiologist is unsure of the radiographic diagnosis between 2 distinct entities (such as PML vs. FLAIR/T2 hyperintensities) then, an automatic recommendation is made to either redo the exam with some other definitive sequence of images that they feel has a better chance of separating those 2 entities, or they might suggest redoing the images in a certain period of time such as 3-6 months so that an evolution or progression could be appreciated. Of course, in the case of PML, the expectation would be that there would CLEAR AND PRESENT clinical symptoms demonstrating disease progress long before radiographic images got any worse.

But again, as I read the phrase above you've supplied in terms of periventricular white matter hyperintensities....I have a very clear picture in my mind of what the radiologist is likely looking at and PML doesn't really enter my mind as something that could be confused or mistaken for it in all honesty.

Now, they say 1 picture is worth 1000 words....so I give you 3 pictures and I'll save you my 3000 words! LOL! These pictures may be somewhat like what the radiologist is seeing in your wife's case. The article that goes along with these 3 pictures is also very well written and explains how very common it is to find such hyperintensities in an MRI and how these lesions themselves can be the cause of some of your wife's symptoms even though the overall read on the brain was "NO STROKE...."

https://betterhealthwhileaging.net/cerebral-small-vessel-disease/



In contrast, here is what PML looks like in its classic form. Now, to be sure this is not a picture of someone who has a JC viral infection but that is not important as much as what a radiologist would tend to call PML (Progressive Multifocal Leukoencephalopathy). I hope you can appreciate the distinct difference in the images of these 2 and how it would be tough for a trained radiologist or neuroradiologist to miss miss one for another.

http://www.msdiscovery.org/sites/default/files/pml.mri_.0000.jpg

If I've provided useful or helpful information to your questions could you do me the utmost of favors in CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information if you'd care to drop me a line at www.bit.ly/drdariushsaghafi as to how your wife is feeling down the road and how things turned out.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns and given you a better direction as to which way a conversation would best be had with your doctor if you feel a discussion needs to take place based on what I've written.

Cheers!

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