case_images: PMC7343350_01
case_images: Neuroimaging changes in PML: (A and B) Multiple T2-hyperintensities revealing a punctate pattern. (C and D) Pre- and post-gadolinium image files revealing a punctate focus of enhancement. (E) Hypointense region observed near the region of abnormality on SWI. (F and G) Interval progression of the punctate lesions evolving into a confluent large white matter lesion. (H and I) Pre- and post-gadolinium features demonstrating increased punctate enhancement in the setting of PML-IRIS after ART initiation. (J) SWI sequence demonstrating a hypointense rim revealing the involvement of the subcortical U-fibers and cortical architecture. ART indicates antiretroviral therapy; IRIS, immune reconstitution inflammatory syndrome; PML, progressive multifocal leukoencephalopathy; SWI, susceptibility-weighted imaging.
case_images: 10.1177_1179573520939339-fig1.jpg
case_images: PMC7343350_01_10.1177_1179573520939339-fig1.jpg
case_images: fig1-1179573520939339
case_images: T2-FLAIR (fluid attenuated inversion recovery) hyperintensities in the cortex, brainstem, cerebellum, subcortical, and periventricular areas (Figure 1A and B). These areas also demonstrated hyperintensity on diffusion weighted imaging (DWI) and few of them revealing T2-shine through on the apparent diffusion coefficient (ADC) sequence. Around the periventricular region, there were areas of punctate enhancement (Figure 1C and D). A hypointense rim involving the subcortical U-fibers on susceptibility-weighted imaging (SWI) was also observed (Figure 1E). U-fibers and extending to the corona radiata, with evolution into a large confluent white matter lesion in the right frontoparietal lobe (Figure 1F and G). There was also increased patchy enhancement along these FLAIR hyperintensities (Figure 1H and