Case 39: MRI Brain

HIV +ve middle aged male, with diorientation

MR findings reveal asymmetric hyperintesitieson T2 & FLAIR sequences, involving both cerebral hemispheres (fronto parietal and occipital lobes) and splenium. These lesions extend to the subcortical white matter.

MRI is the preferred diagnostic imaging modality. It is sensitive to white matter lesions and shows hyperintense lesions on T2-weighted (T2W) images in affected regions.

DIAGNOSIS

Progressive multifocal leukoencephalopathy

DISCUSSION

Lesions are found at the gray matterwhite matter interface and tend to involve the subcortical white matter.??Progressive multifocal leukoencephalopathy (PML) is a fatal subacute progressive demyelinating disease seen in persons with impaired cell-mediated immune response.??Before the AIDS epidemic, PML was rare and associated with other immunocompromised conditions, such as leukemia, lymphoma.?Prognosis is generally is poor with an inexorable neurologic decline leading to comaand death occurring in the majority of patients with PML.

Dr Alpana Karnik