Female, 59 years old, with altered mental status, history of HIV/AIDS, recently hypernatremic. No definite restricted diffusion is seen. Scattered subcortical areas of bright signal on the DWI sequence have no clear ADC correlates and are favored to be artifactual. Parenchymal volume loss is seen diffusely. In addition, confluent white matter T2 hyperintensity is demonstrated affecting the cerebral hemispheres, brainstem and cerebellum. No edema or mass effect is observed. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles and sulci are proportionately prominent consistent with underlying volume loss. On postcontrast images. Mild ependymal enhancement is seen along the frontal horns, the occipital horns, and perhaps minimally at the right temporal horn.
1.Diffuse parenchymal volume loss and confluent white matter signal abnormality are findings compatible with chronic HIV encephalopathy.2.Mild ependymal enhancement is seen involving the frontal and occipital horns bilaterally. This finding is of uncertain significance given the patient's recent medical history. However, the possibility is raised of superimposed infection with resulting ventriculitis, perhaps related to a viral or atypical infectious agent, without excluding other infectious agents. In the context of recent initiation of HAART, the possibility of immune reconstitution inflammatory syndrome can also be considered. Discussed with Dr. Harris at 10:30 AM on 11/21/16.