A risk for developing progressive multifocal leukoencephalopathy is a major barrier to natalizumab use. Extended dosing intervals have been proposed as a way to maintain therapeutic efficacy and reduce progressive multifocal leukoencephalopathy incidence. This is the first reported case of progressive multifocal leukoencephalopathy in a patient using an extended dosing regimen (300 mg/6 weeks). A close clinical and imaging monitoring allowed early detection, which is a major prognostic factor. A favorable outcome was seen with a therapy comprising plasma exchange therapy, mirtazapine, mefloquine and cidofovir. Further studies will be needed to assess the potential role of extended dosing intervals to improve prognosis in patients receiving natalizumab and also to measure its impact clinically and/or radiologically.

DPTH is a relatively frequent cause of ICH in young adults. There is no relationship with intensity of the previous head injury. The more frequent location deep in the hemisphere may be related to the younger age of our patients compared with those of other published series. The good outcome in our patients may be related to their youth and the absence of complications such as skull fracture, need for neurosurgery, or coagulation disorders.

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