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Progressive multifocal leukoencephalopathy (PML) is one of the most severe opportunistic diseases of the central nervous system, which leads to multiple demyelination of brain structures, neurological symptoms and frequent death or disability of the patient. The etiological factor of this disease is Human polyomavirus 2 (JCPyV).This pathogen is widespread – antibodies are found in 80% of the world›s population. However, the clinical symptoms of this infection appear only in people with a pronounced decline in cellular immunity. Until 1980 progressive multifocal leukoencephalopathy was extremely rarely diagnosed. Now days the main cause of the clinical symptoms of PML is immunodeficiency caused by HIV infection. Clinical manifestations of PML are characterized by various non-specific neurological symptoms, similar to other lesions of the central nervous system, the symptoms progress slowly over several months, and usually lead to death. Diagnosis of PML is based on laboratory and instrumental methods, such as DNA JCPyV detection in the cerebrospinal fluid, brain biopsy, and radiation diagnostic methods. There is no effective prevention and etiotropic therapy for PML. Improved parameters of cellular immunity and antiretroviral treatment in HIV positive patients significantly increase the life expectancy of patients with PML. Despite the ability of drugs to prevent the progression of the disease, pathological changes in the brain are irreversible and lead to persistent disability of patients, therefore, it is necessary to diagnose PML in the early stages of the disease.

Focal central nervous system damage can be a result of infectious process in brain or spinal cord, autoimmune or hypoxic-ischemic process and a relationship of these processes. Difficulties in differential diagnosis of variant pathogenic focuses in central nervous system are related with absence of specific clinical and laboratory data. In such cases brain biopsy can help to make right diagnosis. In this article we characterized diagnostical process in teenage girl with progressive case of acute disseminated encephalomyelitis and vegetative status as complication, though she got large doses of steroids and intravenous immunoglobulins at the disease onset, with positive dynamic as a result of prolonged antiviral therapy. The diagnosis was made only by brain biopsy – we found herpesviral brain damage, further the disease transformed in multiple sclerosis.

We describe clinical case of Rasmussen's encephalitis in a 24-year-old woman that occurred during her hospital stay. Its clinical manifestations included a clonic movement disorder and partial epilepsy. Brain magnetic resonance imaging study showed shrinkage of her left hemisphere with signs of inflammation and scarring. An electroencephalography showed the electrophysiological characteristics of epilepsy and slowing down of the left hemisphere activity. Brain biopsy was not provided.