Table 1.
Path to diagnosis | Diagnostic features | Diagnosisa | |||
---|---|---|---|---|---|
Definite PML | Probable PML | Possible PML | Not PML | ||
Neuropathological | Histopathological triad of demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei | Histopathological triad with detection of JCV protein and/or JCV DNA | Histopathological triad only | Detection of JCV protein only | No histopathological evidence of JCV infection |
JCV protein detected in focal brain lesions by immunohistochemistry or electron microscopy | |||||
JCV DNA detected in focal brain lesions by in situ hybridization or PCR | |||||
Combined clinical, radiological and laboratory | Clinical: progressive neurological symptoms | JCV DNA detected in the CSF, and both imaging features and clinical features present | JCV DNA detected in the CSF and either imaging or clinical features present | Imaging and clinical features only, or only detection of JCV DNA in the CSF | Isolated clinical or imaging features |
Imaging: MRI features | |||||
Laboratory: JCV DNA detected in the CSF by PCR |
CSF, cerebrospinal fluid; JCV, JC virus; PCR, polymerase chain reaction; PML, progressive multifocal leukoencephalopathy. aCriteria are compiled from ref.64.