A Patient with Progressive Multifocal Leukoencephalopathy Who Developed Bálint Syndrome Improved by Combination Therapy Using Mefloquine and Mirtazapine Akira Takekoshi 1 , Nobuaki Yoshikura 1 , Kenji Ozawa 2 , Yoshikazu Ikoma 3 , Junichi Kitagawa 3 , Akari Takeshima 4 , Mika Otsuki 5 , Kazuo Nakamichi 6 , Masayuki Saijo 6 , Naoyuki Ohe 7 , Kiyofumi Mochizuki 2 , Akiyoshi Kakita 4 , Takayoshi Shimohata 1 1Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine 2Department of Ophthalmology, Gifu University Graduate School of Medicine 3Department of Hematology and Infectious Diseases, Gifu University Graduate School of Medicine 4Department of Pathology, Brain Research Institute, Niigata University 5Graduate School of Health Sciences, Hokkaido University 6Department of Virology 1, National Institute of Infectious Diseases 7Department of Neurosurgery, Gifu University Graduate School of Medicine Keyword: 進行性多巣性白質脳症 , Bálint症候群 , 塩酸メフロキン , ミルタザピン , progressive multifocal encephalopathy , Bálint syndrome , mefloquine , mirtazapine pp.281-286
Published Date 2019/3/1
DOI https://doi.org/10.11477/mf.1416201256
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We describe a 62-year-old man who developed subacute visual loss after cord blood stem cell transplantation for malignant lymphoma. Brain magnetic resonance imaging (MRI) showed bilateral hyperintense lesions in the occipital and parietal lobes. A diagnosis of progressive multifocal encephalopathy (PML) was established following brain biopsy and detection of JC virus (JCV) deoxyribonucleic acid (DNA) in the cerebrospinal fluid (CSF). He developed optic ataxia and visual inattention, and was then diagnosed as having Bálint syndrome. After he was treated with mefloquine and mirtazapine, his Bálint syndrome and, MRI findings improved and the copy number of JCV DNA in the CSF decreased. In summary, we demonstrate that patient with PML may develop Bálint syndrome and that combination therapy using mefloquine and mirtazapine may be an effective treatment.

(Received August 23, 2018; Accepted November 29, 2018; Published March 1, 2019)

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