 There are scattered foci of T2 hyperintensity within subcortical white matter, pons, as well as the cerebellum, without associated restricted diffusion or susceptibility abnormality. The cerebellar foci have an appearance more like tiny foci of encephalomalacia, although one contrast enhances on the current exam (although not on the recent enhanced CT scan). The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.
There are scattered foci of T2 hyperintensity within subcortical white matter, pons, as well as the cerebellum, without associated restricted diffusion or susceptibility abnormality. The cerebellar foci have an appearance more like tiny foci of encephalomalacia, although one contrast enhances on the current exam (although not on the recent enhanced CT scan). This constellation of imaging features is most suggestive of small vessel ischemic disease, with the one cerebellar lesion demonstrating enhancement likely representing a tiny focus of subacute ischemia. Other complications of HIV such as PML, primary HIV encephalopathy, infection, or metastasis are felt to be unlikely.