 Brain MRIThere are interval development of confluent, patchy and fairly symmetric FLAIR high signal intensity lesions involving bilateral frontal, parietal, temporal and occipital lobes. Most of these lesions appear to be progressed and coalesced from previously seen somewhat scattered FLAIR high signal lesions. However, there is no evidence of mass effects nor evidence of contrast enhancement. There is no evidence of associated global atrophy. Constellation of these findings indicate progressive multifocal leukoencephalopathy. Differential diagnosis include other demyelinating disease, HIV encephalitis, Mitochondrial encephalopathies such as MELAS, Acute disseminated encephalomyelitis (ADEM) and vasculitis. Possibility of HIV related infection such as toxoplasmosis or lymphoma is less likely considering lack of mass effects and contrast enhancement.Previously seen other scattered FLAIR/T2 high signal intensity lesions on bilateral white matter including brain stem, right middle cerebellar peduncle and bilateral cerebellar parenchyme, unchanged. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. Unchanged about 2mm lower lying cerebellar tonsils.No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.MRA HEAD
1. Interval progression of previously seen FLAIR high signal intensity lesions and results bilateral confluent fairly symmetric white matter lesions without evidence of mass effects nor evidence of contrast enhancement. PML is the likely diagnosis, however, differential diagnosis of other demyelinating disease, HIV encephalitis, MELAS, ADEM and vasculitis may need to be excluded.2. No evidence of acute ischemic or hemorrhagic lesion.3. Spinal cord signal intensity is normal.4. Disc protrusion, central to right with right mild to moderate lateral recess stenosis at C56. 