A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section ©

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A 52-year old man with recently diagnosed HIV infection with irregular shaking of his hand Teaching NeuroImages Neurology Resident and Fellow Section © 2014 American Academy of Neurology

Vignette A 52-year old man with recently diagnosed HIV infection (CD4 count 105/ µl; normal range / µL) presented with 5-week history of irregular shaking of his left hand triggered by lifting his arm accompanied by “feeling of stiffness and clumsiness”. On clinical examination, focal myoclonus with positive and negative components affecting the left upper limb with distal predominance was detected (Video). Katchanov et al. © 2014 American Academy of Neurology

Katchanov et al. Imaging © 2014 American Academy of Neurology

Focal cortical myoclonus in progressive multifocal leukoencephalopathy Cerebral MRI revealed a demyelinating lesion affecting the juxtacortical white matter of the precentral gyrus (Figure). The CSF PCR for JC-virus was strongly positive confirming the diagnosis of progressive multifocal leucoencephalopathy Katchanov et al. © 2014 American Academy of Neurology