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There is confluent, somewhat symmetric, multifocal, frontal and parieto-occipital periventricular and sub-cortical demyelination. There is brainstem involvement additionally (especially midbrain and pons). The cerebellar hemispheres are spared. There is no mass effect, no perilesional oedema, negative diffusion and ADC mapping and no abnormal enhancement. There is no optic neuritis. MRI brain is otherwise normal.
Non-enhancing and non-necrotic anterior and posterior cervical chain lymphadenopathy are consistent with the known HIV status (best appreciated on sagittal imaging). In addition the heterogeneous parotid gland appearance allude to HIV and benign lymphoepithelial lesions.
(Axial T1 pre contrast is unavailable).