Diagnosis: Unspecified convulsionsClinical question: first time seizureSigns and Symptoms: HIV, first time seizure The CSF spaces are appropriate for the patient's stated age with no midline shift. There is T2 and FLAIR heterogeneous signal hyperintensity in the basal ganglia bilaterally. There is no associated diffusion restriction.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
Bilateral basal ganglia lesions. The differential is fairly broad and includes lymphoma and infections (cryptococcus, toxoplasma and viral) as well as neurodegenerative/metabolic causes such as Wilson disease and Huntington disease . Although included in the differential, its distribution and appearance is not typical for hypoglycemic encephalopathy, ischemia, CJD and extrapontine myelinolysis.