Magnetic resonance imaging and the acquired immunodeficiency syndrome dementia complex

It is now recognized that patients infected by the virus linked to the acquired immunodeficiency syndrome (AIDS) can develop dementia symptoms as the initial and sometimes only symptomatology for AIDS. This appears to be a syndrome whose origin is independent of secondary non-viral infection or malignancy. Magnetic resonance imaging (MRI) in three patients with well documented AIDS dementia revealed high signal periventricular white matter lesions. In one case, large lesions were not apparent on computed tomography and gross inspection of the fixed brain prior to autopsy. In two cases in which serial in vivo MR studies were obtained, there was a progressive increase in lesion volume over a short (several months) period of observation. Periventricular white matter lesions may be an early sign accompanying AIDS dementia, and the degree of changes correlated well with the clinical picture in our patients.