AIDS-RELATED MR HYPERINTENSITY OF THE BASAL GANGLIA

PURPOSE: Our goal was to describe the MR imaging appearance and clinic al pathologic correlates of bilateral basal ganglia hyperintensity in acquired immunodeficiency syndrome (AIDS). METHODS: Medical records an d laboratory data were reviewed retrospectively in nine cases of bilat eral basal ganglia hyperintensity on long-repetition-time MR images. O pportunistic infections of the central nervous system were excluded by clinical and laboratory data. Postmortem neuropathologic examination was obtained in two cases. RESULTS: All patients presented acutely wit h new seizures or changes in mental status. A history of drug abuse wa s elicited in seven of the nine remaining patients. Renal failure was present in six cases. Symmetric bilateral caudate and putamen hyperint ensity on T2-weighted images was found in all cases with variable exte nsion to the surrounding white matter, thalamus, and brain stem. Postm ortem neuropathologic examination in two cases revealed numerous micro infarcts in a distribution similar to the MR signal abnormalities. CON CLUSION: The MR appearance of basal ganglia hyperintensity in this ser ies of AIDS patients represents ischemic tissue injury. We propose tha t this clinicopathologic entity is precipitated by the combined effect s of human immunodeficiency virus infection and drug use, particularly cocaine and/or associated toxic contaminants.