23 December 2011

PML in HIV - Cerebellum

HIV patient with poor immune status presents with gait disturbance and dysdiadochokinesia. MRI reveals asymmetric primary white matter changes mostly in the left cerebellum. Note high signal on T2 and FLAIR as well as some volume increase and discrete contrast enhancement. Radiological signs together with clinical status correspond with Progressive Multifocal Leukoencephalopathy (PML). Diagnosis is not easy since HIV patients can suffer from other opportunistic infections and lymphoma. Clue here is asymmetry, infratentorial location and patient's clinical status. (See Fig 18.16 MRI of Brain and Spine, S. W. Atlas, 4th, p 943). You might also check my previous PML cases: PML 1, PML 2.