24-year-old female with seizure, prior abnormal MRI and CT, evaluate for HIV encephalopathy, PML, or other. Several sequences are motion degraded. Given this caveat:Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. For example the confluent nature of the centrum semiovale has significantly improved, and hyperintense abnormality within the basal ganglia remains significantly improved when compared to the older MRI of 10/11/2015. The previously noted more conspicuous rounded hypodense foci on the most recent CT correlates with a small focus of residual T2 hypointensity that has remained in a prior region of confluent abnormality. However, T2 hyperintensity has progressed within bilateral subinsular white matter. Additionally, T2 hyperintensity within the cerebellum is less conspicuous, however more confluent.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Scattered foci of mucosal thickening can be found throughout the paranasal sinuses without superimposed fluid levels. Mastoid air cells remain clear.
Redemonstrated is bihemispheric T2 hyperintensity within the white matter and to a lesser extent basal ganglia and infratentorial structures. Globally, there has been overall reduction in the degree of T2 hyperintense abnormality, although this includes regions of improvement, regions of progression, and new signal foci in the other areas. Given the asymmetry, PML is considered most likely. CMV infection can also present involving the white matter with asymmetry. Primary HIV encephalopathy most often represents in a symmetric faction and thus is considered less likely.