Case of the Month: October, 2010

Submitted by Michael Witkosky and E. James Tourje, MD.

32 year old male recently diagnosed with HIV. The patient presented to the emergency room with lethargy, agitation, and right sided weakness. CT scan of the brain without intravenous contrast showed multiple bilateral low attenuation white matter lesions within the cerebral hemispheres. Subsequent MRI is shown below:

T2 FLAIR

T1 POST CONTRAST

DWI

ADC MAPS

Question: Which answer best describes the findings?

1. Multiple asymmetric white matter lesions with FLAIR hyperintensity and peripheral enhancement (ADEM)
2. Prediliction for periventricular white matter
3. Scattered asymmetric white matter lesions without enhancement
4. Multi-focal grey matter/white matter lesions in the cortical/subcortical, basal ganglia, and thalamic portions of the brain