Correspondence regarding: a novel cerebral microangiopathy with endothelial cell atypia and multifocal white matter lesions: a direct mycoplasmal infection? J Neuropathol Exp Neurol 2007;66: 1100-17.

A 31-year-old man with no previous pertinent medical or surgical history presented with seizures and a progressive cognitive decline. He became tremulous, and he had a variable but constant fine action tremor. There were saccadic eye movements on voluntary gaze to either side. He developed myoclonus superimposed on psychomotor slowing with periods of agitation, followed by incoordination, suggesting mild cerebellar dysfunction. There were no other abnormal neurological findings. Laboratory investigation included an elevated protein level in the cerebrospinal fluid and nonspecific slowing in an electroencephalogram. Computed tomography and magnetic resonance imaging of brain and spinal cord were normal, and brain scan showed no indication of cerebral blood flow changes; an extensive metabolic workup was negative. The dementia seemed to progress more rapidly than expected from most metabolic or other dementing diseases; 8 months into his course, a left frontal lobe biopsy was performed, revealing rare microvascular endothelial cell nuclear clusters (Fig. A). FIGURE (A) Frontal lobe biopsy blood vessel has clusters of atypical vascular endothelial cell nuclei and a widened lumen. …