Not all strokes are strokes: A bizzare case!
The following case has been reported in the European Journal of Case Reports in Internal Medicine.

A 72-year-old woman presented with a complex partial seizure and right hemiparesis, after a four-week history of cognitive decline, apraxia and speech disturbance.

She previously had chronic lymphocytic leukaemia (CLL) and had finished chemotherapy one year prior to presentation. She was receiving monthly intravenous immunoglobulins for bronchiectasis.

Brain imaging revealed hypodensity in the left temporo-parietal regions. Cerebrospinal fluid was positive for the JC virus, leading to a diagnosis of progressive multifocal leucoencephalopathy (PML).

• This case highlights new insights into an uncommon but important condition: always consider progressive multifocal leucoencephalopathy when immunocompromised patients present with neurological symptoms.

• A full differential diagnosis should always be considered, even in the context of a more ‘plausible’ diagnosis.

• Avoid premature closure and confirmation bias as cognitive errors in diagnostic reasoning.

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