Findings
- Infratentorial and supratentorial patchy T2/FLAIR hyperintensities involving the bilateral middle cerebellar peduncles, left superior cerebellar peduncle, left greater than right midbrain and cerebral peduncles, right greater than left lentiform nuclei, and the periventricular white matter, particularly in the bilateral temporal and left parietal lobes
- No significant associated mass effect, restricted diffusion, or enhancement
- No evidence of acute infarct, hemorrhage, or hydrocephalus
- Mild generalized cerebral volume loss
- Mild diffuse smooth dural thickening
- Trace mucosal thickening of the right maxillary sinus
Diagnosis
Progressive multifocal leukoencephalopathy (PML)
Sample Report
Asymmetric bilateral patchy infratentorial and supratentorial patchy T2/FLAIR hyperintensities predominantly involving white matter without significant associated mass effect, restricted diffusion, or enhancement. This imaging appearance is most suggestive of progressive multifocal leukoencephalopathy (PML). Lymphoma is considered less likely given lack of mass effect, restricted diffusion, and enhancement, though lack of enhancement can be seen in the setting of steroid treatment.
No evidence of acute infarct, hemorrhage, or hydrocephalus.
Mild diffuse smooth dural thickening, which is nonspecific and could relate to prior intrathecal access, intracranial hypotension, or less likely, involvement by lymphoma.
Mild generalized cerebral atrophy.
Discussion
References