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Neurological Rehabilitation

A Case Report: Management of Progressive Multifocal Leukoencephalopathy As Physiatrists

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 6

    Co-Author(s)

  • Min Ju Kim, DO

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

    • Poster Presenter(s)

  • Rohan Gogoi, MD

    Resident Physician
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Scarsdale, New York

    • Co-Author(s)

  • JS

    Joseph Seldin, MD

    Attending
    NYC Health + Hospitals/North Central Bronx
    Mamaroneck, New York

Disclosure(s):
Min Ju Kim, DO: No financial relationships to disclose
Rohan Gogoi, MD: No financial relationships to disclose
Case Diagnosis: We present a case of a 58-year-old female with a history of asthma and uterine fibroids, who was found to have Progressive Multifocal Leukoencephalopathy (PML) secondary to HIV infection.

Case Description or Program Description: Patient initially presented to the hospital after developing acute onset right leg weakness, resulting in a fall. The patient received an MRI brain as part of a stroke work up given her focal neurologic deficits. However, rather than acute ischemia, the patient’s MRI brain revealed encephalomalacia and gliosis of the left frontoparietal lobe. Her bloodwork was revealed to be positive for HIV, a diagnosis of which she was previously unaware prior to this admission. Her HIV positive status, combined with imaging findings, raised concern for progressive multifocal leukoencephalopathy (PML). A subsequent lumbar puncture confirmed the presence of JC virus. Throughout her admission, the patient continued to develop further neurological symptoms, including persistent right leg and arm weakness, right arm spasticity with Modified Ashworth Scale of 1+, and cognitive deficits.

Setting: acute inpatient rehabilitation facility

Assessment/Results: At 2 weeks of rehabilitation, she demonstrated measurable improvement in her functional status with physical and occupational therapy. Her ambulation distance increased from 10 ft to 50 ft, and she was able to improve from moderate assistance to minimal assistance with all transfers. Patient was also started on baclofen with moderate relief in right arm spasticity.

Discussion (relevance): While the specific functional prognosis and long-term recovery patterns of patients with PML from JC virus are uncertain, this patient's clinical course appeared to resemble that of an acute stroke. Her stroke-like symptoms, as well as her positive response to therapy, suggests that patients with neurological deficits from PML may benefit from rehabilitation approaches similar to those used for stroke recovery.

Conclusions: As physiatrists, it is crucial to understand the presentations of PML, and the management of patients from a rehabilitation standpoint.