Brain MRI in 4 of 13 patients who survived 10 or more years after the onset of PML symptoms

Case 1: A 37-year-old HIV-infected woman was nonadherent with her combined antiretroviral therapy for two years and presented with dysarthria and left hand clumsiness.
(A) T2-weighted FLAIR sequences revealed a large zone of hyperintensity involving the right frontal lobe, extending into the deep white matter and sparing the cortical ribbon.
(B) Follow-up MRI 12 years later demonstrated tissue loss involving the right frontal lobe with associated ex vacuo dilatation of the frontal horn of the right lateral ventricle.
Case 2: a 39-year-old HIV-infected man presented with gait ataxia and falls.
(C) MRI revealed T2/FLAIR hyperintensity predominantly involving the left cerebellar hemisphere.
(D) Follow-up MRI 12 years later demonstrated severe cerebellar and brainstem volume loss.
Case 3: a 48-year-old injection drug user presented with behavioral changes, seizures, and aphasia and was found to be HIV infected.
(E) MRI revealed multifocal areas of subcortical T2/FLAIR hyperintensity.
(F) Follow-up MRI 10 years later revealed asymmetric volume loss.