Patient presents with confusion.
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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 in the deep and subcortical white matter involving the entire brain.
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.
- Mahan M, Karl M, Gordon S. Neuroimaging of viral infections of the central nervous system. Handb Clin Neurol. 2014;123:149-73. doi: 10.1016/B978-0-444-53488-0.00006-7.