Presentation
Progressive weakness, vague complaints.
Patient Data
Asymmetrical, confluent, patchy T2/FLAIR hyperintensities are seen involving periventricular, deep and subcortical white matter of bilateral frontoparietal lobes, bilateral external capsules, corpus callosum, left internal capsule, left cerebral peduncle, pons, medulla oblongata, bilateral middle cerebellar peduncles and cerebellar hemispheres. Areas of mild diffusion restriction are seen at periphery of few of these lesions.
Diffuse cerebral atrophy is seen with prominence of bilateral lateral, third ventricles and convexity sulci.
Case Discussion
On further probing, patient was found to be HIV positive. Above imaging findings in context of the given history are typical of progressive multifocal leukoencephalopathy (PML).