PMC9144385_01
Legend: Magnetic resonance image of brain showing confluent increased FLAIR signal intensity involving the subcortical and periventricular white matter and sparing of gray matter of the right parietal-occipital lobes and right temporal lobe.
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T2 hyperintense, T1 hypointense which did not enhance with gadolinium administration (Fig. 1). The imaging findings were strongly suggestive of PML, but differential diagnosis included viral encephalitis and acute disseminated encephalomyelitis.
Legend: Follow-up magnetic resonance imaging showing interval progression of foci primarily white matter signal abnormality, involving the right greater than left hemisphere, with involvement of the splenium of the corpus callosum, extension to the parietal occipital white matter.
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The patient's presentation was consistent with the progression of PML supported by the progression of white matter lesions on repeat brain MRI [Fig. 2].
Legend: Follow up magnetic resonance imaging of the brain showing extension of FLAIR signal to the right frontal lobe, temporal lobe, and parietal occipital lobes. Progression of confluence across the midline via the splenium of the corpus callosum with involvement of the left posterior temporal-parietal occipital noted.
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Due to deteriorating neurological status, a repeated brain MRI was performed which showed further progression of PML (Fig. 3).