 There is no acute infarct or midline shift. There is area of T2 hyperintensity corresponding to the right frontal lobe hypoattenuation seen on prior CT with mild regional mass effect. There is also asymmetric hyperintense T2 signal diffusely involving the right putamen with mild expansion, and to a somewhat lesser degree in the left putamen. The patient was not administered gadolinium due to low GFR of 11. There is a background of mild periventricular and subcortical white matter T2 signal abnormality which is nonspecific. There is nonspecific irregular and somewhat nodular thickening of the superficial perioral and nasal soft tissues.
Nonspecific hyperintense T2 signal diffusely involving the bilateral putamen (right greater than left), and right frontal lobe subcortical white matter, associated with mild mass-effect. These are superimposed on additional nonspecific moderate subcortical and periventricular white matter T2 signal abnormalities. Evaluation limited due to lack of contrast. Provided the history, the differential diagnosis primarily includes cryptococcosis, although other infectious etiologies such as tuberculosis, toxoplasmosis, inflammatory, and neoplastic etiologies are possible. Continued imaging follow-up is suggested as clinically warranted.