Presentation
A newly diagnosed AIDS patient presented with neurological deterioration. No fever. Had a CD4 count of 130 cells/microliter. CSF analysis excluded TB or pyogenic meningitis.
Patient Data
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There is bilateral periventricular and subcortical white matter T2 hyperintensities, more prominent around the trigone regions. There is relative sparing of the cortex. No significant associated mass effect. No brain swelling. Associated of diffusion restriction is evident on DWI.
Case Discussion
Progressive multifocal leukoencephalopathy is a demyelinating process results from JC virus infection and seen in advanced HIV infection, typically when CD4 counts of less than 150 cells/microliter. Typical white matter lesions are multifocal, periventricular and subcortical (involving U fibers).