24 years Female (DOB:7/11/1991)Reason: Patient with HIV, ESRD, seizures w/ brain lesions seen on MRI concern for HIV encephalopathy, toxo, PML, vs. other History: SeizuresPROVIDER/ATTENDING NAME: MADHU C YARLAGADDA MADHU C YARLAGADDA The CSF spaces are appropriate for the patient's stated age with no midline shift. There are patchy but confluent periventricular white matter lesions present bilaterally but mildly asymmetrically which were also present on the prior exam and are unchanged. These are not associated with contrast enhancement. They do not involve the u-fibers. There is no evidence of a dependable enhancement or intraparenchymal enhancement.A punctate signal hypointensity on susceptibility weighted imaging is present in the body of the right caudate nucleus which was also present on the prior exam. It is also identified on coronal T2 imaging.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.
There are patchy periventricular white matter lesions present bilaterally but mildly asymmetrically. These are nonspecific. It's possible that they are related to demyelination. This is not particularly characteristic of a specific infectious cause. In the setting of HIV their pattern and location in part suggest HIV encephalopathy though asymmetry is somewhat atypical for this. Alternative considerations include CMV encephalitis (however, there is relative lack of appendiceal malignant enhancement and prominent and PML (which often involves the u-fibers) as well as demyelination due to other causes.