Female, 57 years old, with worsening mental status, known JC numerous infection/PML. Planning for JC treatment, requesting baseline MRI. Since the prior examination, ill-defined restricted diffusion and thickening have progressed in the left periatrial white matter. Abnormal restricted diffusion also appears more conspicuous along the left occipital and temporal horns, within the splenium of the corpus callosum, and along the right occipital and temporal horns. Corresponding T2 signal abnormality is also seen.Scattered areas of subcortical T2 hyperintensity in both cerebral hemispheres are redemonstrated showing no significant interval change over multiple prior exams. A small area of encephalomalacia is also unchanged in the left frontal lobe. No abnormal fluid collections are detected. The ventricles are not dilated and, in fact, appear slightly effaced by the periventricular process as described above.
Restricted diffusion and mild thickening have progressed in the left periatrial white matter, as well as within the splenium of corpus callosum and along the bilateral occipital and temporal horns. Given the clinical history, the findings would be consistent with worsening PML.