HIV patient with rapidly progressing neurological symptoms with paraparesis. MR Spine shows diffusely increased signal on T2 in medulla consistent with edema. There are also patchy contrast enhancement regions in medulla oblongata and cervical medulla (arrowheads). There is even leptomeningeal contrast enhancement in the conus region (arrows). Finding in this case is consistent with HIV Myelitis that is caused by virus attacking spinal monocytes and macrophages. However even opportunistic infection can not be excluded in such cases. In general above radiological findings are not specific and there is a large list of differential diagnosis. Therefore diagnosis is not based solely on MR imaging. Additionally in this patient the preexistent cervical discopathy requires attention due to increased focal spinal stenosis due to spinal myelitis.
4/ 5Oleh Habifa