HIV encephalopathy

Case contributed by Coenraad Hattingh


Patient presents with confusion.

Patient Data

Age: 50 years
Gender: Male

The brain, brainstem and cerebellum are strikingly atrophic for this patient’s age. 

There is asymmetrical atrophy of the hippocampi, where the right hippocampus appears sclerotic. 

There is diffuse T2 high signal (on FLAIR) in the deep and subcortical white matter involving the entire brain. 

Case Discussion

This patient is HIV positive and not on antiretroviral therapy and had a CD4 200 cells/μL.

HIV-1 encephalitis/encephalopathy (HIVE) results from direct HIV infection of the brain. Typically, and in this case, opportunistic infections are absent. Cognitive, behavioral, and motor abnormalities are typically present in 25-70% of cases. This patient presented with confusion. Imaging typically demonstrates atrophy with bilateral diffuse white matter abnormalities.

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