Increasing dementia in an immunocompromised patient. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of high T2 signal in the cerebral white matter bilaterally. The brainstem and cerebellum appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild staphylomatous deformity of the bilateral globes.
A few punctate foci of high T2 signal in the cerebral white matter bilaterally are nonspecific and may represent chronic small vessel ischemic disease or perhaps sequela of infection, but characterization is limited without intravenous contrast. No evidence of acute intracranial hemorrhage, mass, or acute infarct.