When a Stroke Is Not a Stroke

Presenting Complaint

A 51-year-old man with AIDS presented to the emergency department with right-sided weakness, diplopia, dysarthria, and gait disturbance.
History of Presenting Illness

The patient awoke with numbness of the right side of his face, arm, and leg 8 days earlier. After arising from bed that morning, he noted difficulty lifting objects with his right arm because of weakness, and a tendency to veer to the right when walking. These symptoms subsequently became slightly worse, and he developed horizontal diplopia and dysarthria within a few days. His weakness and gait instability became significantly worse, and he came to the emergency department because he could no longer walk.
Past Medical History

The patient was known to be HIV-positive for 10 years. His most recent CD4+ cell count, 4 months earlier, was 32/mm3. His viral load was unknown. At that time, he began highly active antiretroviral therapy (HAART). His history was also significant for an episode of Pneumocystis carinii pneumonia (PCP), and hepatitis C, cardiomyopathy, chronic renal insufficiency, and anemia.
Medications

Medications at the time of presentation included trimethoprim-sulfamethoxazole, atazanavir, tenofovir, valacyclovir, and lamivudine/zidovudine. He had no known allergies.
Family History

The patient's mother had coronary artery disease. He had 1 daughter who was in good health.
Social History

The patient was divorced, and resided with ex-wife and a friend. He had a 30-plus pack-year smoking history. He denied past or present use of alcohol. He reported a remote history of injected drug use; he quit 5 years before presentation.

Final Diagnosis

Progressive Multifocal Leukoencephalopathy

diagnosis nak gile2 je... hoho