HIV, heroin abuse. Recently admitted with ataxia and neurocognitive changes. MRI showed cerebellar lesion and white matter lesions. Here again with the same presentation, repeat imaging for many acute changes. There are multiple scattered foci of predominantly subcortical white matter T2 hyperintensity without restricted diffusion, which have not significantly changed. There is also patchy T2 hyperintensity and swelling within the central pons and within the medial cerebellar hemisphere white matter, with increase in size of the left cerebellar lesion. The cerebellar tonsils remain mildly low-lying. There is a punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. The calvarial bone marrow is diffusely heterogeneous. The adenoids are prominent and contain punctate retention cysts. There are bilateral partially imaged parotid nodules.
1. Multiple supratentorial and infratentorial white matter lesions that likely represent the effects of opiate intoxication have not significantly changed except for a left cerebellar lesion, which has enlarged, but no evidence of acute intracranial hemorrhage or acute infarct.2. An unchanged punctate focus of susceptibility effect in the periventricular white matter adjacent to the frontal horn of the left lateral ventricle is nonspecific. 3. Nonspecific prominence of the adenoids may be related to HIV, for example.4. The appearance of the calvarial bone marrow may also be attributable to HIV. 5. Bilateral partially imaged parotid nodules may represent lymphoepithelial lesions. Dedicated imaging of the neck and parotid gland may provide further insights, nevertheless.