52 years Female (DOB:12/11/1963)Reason: eval for primary CNS lymphoma, PML, toxoplasma encephalitis, or other CNS malignancy or infection History: HIV, gait instability, cognitive impairment, recently started HART, hx "brain cancer"PROVIDER/ATTENDING NAME: GEORGE W WEYER GEORGE W WEYER There is redemonstration of abnormal signal in the right cerebellar hemisphere white matter without associated contrast enhancing lesion. It is associated with T2 and FLAIR signal hyperintensity and T1 signal hypointensity with involvement of the white matter of the right cerebellar hemisphere and the right middle cerebellar peduncle. This is stable since the prior exam.There are patchy foci of T2 and FLAIR hyperintensity in the medulla, pons and lower midbrain. This is stable since the prior exam.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a small focus of susceptibility effect present adjacent to the frontal horn of the left lateral ventricle. It is not seen on any of the other pulse sequences.No abnormal enhancing mass lesions are appreciated intracranially.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 demonstrate some small opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The nasopharyngeal adenoids are large which could be a manifestation of HIV.
1.There is a right cerebellar white matter lesion present. Differential considerations may include demyelinating focus including PML. Other lack of contrast enhancement makes lymphoma and toxoplasmosis less likely these diagnosis cannot be entirely excluded.2.Periventricular and subcortical white matter signal changes of a mild to moderate degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 3.There are patchy lesions present in the brainstem which are nonspecific.4.There is a microhemorrhage present adjacent to the frontal horn of the left lateral ventricle. It is of unclear significance in isolation.