Presentation
Weakness.
Patient Data
Large T2 / FLAIR white matter hyperintensity is seen in the right frontoparietal lobes, predominantly involving white matter, abutting the overlying cortex and extending up to periventricular white matter and posterior limb of the right internal capsule. It also involves the body of the corpus callosum and extends towards the left side. Peripheral DWI hyperintensity is seen with heterogeneous enhancement along the medial aspect of the lesion.
Another T2 / FLAIR hyperintensity in the right frontal lobe. Peripheral DWI hyperintensity is seen with no obvious enhancement.
Lobulated enhancing suprasellar lesion in the suprasellar region. The lesion is closely abutting the pituitary gland inferiorly and splaying optic chiasma superiorly. No obvious extension into cavernous sinuses is seen. The lesion shows a slightly different signal intensity compared to the adjacent pituitary gland on T2 and post contrast images, possibly papillary craniopharyngioma / suprasellar meningioma. Other possibility of macroadenoma appears less likely, though cannot be entirely ruled out.
Case Discussion
The patient was recently diagnosed to be HIV positive. In this context, the above findings suggest likelihood of progressive multifocal leukoencephalopathy.
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