Advanced HIV/AIDS (CD4 <20), nonadherent to medications; experiencing "regression" as per her report. Difficulty with gross motor skills, coordination. Concern for PML versus space-occupying lesion or other infectious process. There is marked diffuse cerebellar volume loss, without signal abnormalities. Otherwise, the brainstem, cerebral hemispheres, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The third and lateral ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is moderate diffuse paranasal sinus mucosal thickening.
1. Extensive diffuse cerebellar volume loss may represent a primary cerebellar degeneration associated with HIV, for which JC virus variant has been implicated.2. No evidence of progressive multifocal leukoencephalopathy, abscess, or acute infarct. REFERENCES:1. Elsheikh BH, Maher WE, Kissel JT. Cerebellar atrophy associated with human immunodeficiency virus infection. Arch Neurol. 2010 May;67(5):634-5. 2. Roux D, Bouldouyre MA, Mercier-Delarue S, Seilhean D, Zagdanski AM, Delaugerre C, Simon F, Molina JM, Legoff J. JC virus variant associated with cerebellar atrophy in a patient with AIDS. J Clin Microbiol. 2011 Jun;49(6):2196-9. 