HIV on HART, polysubstance abuse, reported h/o brain tumor, multiple falls, slurred speech, dysmetria although confounded by admitting to opiate intoxication. There are multiple scattered foci of predominantly subcortical white matter T2 hyperintensity without restricted diffusion. There is also patchy T2 hyperintensity and swelling within the central pons and within the medial cerebellar hemisphere white matter, right greater than left. The cerebellar tonsils are mildly low-lying. There is a punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle, with what appears to be adjacent linear susceptibility effect. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarial bone marrow is diffusely heterogenous. The adenoids are prominent. There is mild diffuse paranasal sinus mucosal thickening.
1. Multiple supratentorial and infratentorial white matter lesions may represent progressive multifocal leukoencephalopathy or other opportunistic infection, the primary effects of HIV, neoplasm, such as CNS lymphoma, and/or the effects of opiate intoxication, with what may represent mild tonsillar herniation versus baseline low-lying tonsils. However, assessment is limited due to the lack of intravenous contrast. Otherwise, no evidence of acute intracranial hemorrhage or acute infarct.2. A punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle may represent a cavernous malformation associated with a developmental venous anomaly. 3. Nonspecific prominence of the adenoids may be related to HIV, for example.4. The appearance of the calvarial bone marrow may also be attributable to HIV. 