Fig 4.

CNS VZV–IRIS (same patient as in Fig 3). Initial MR imaging of the brain shows, on axial FLAIR (A and B) and contrast T1WI (C and D), bilateral hyperintense signal abnormalities without restricted diffusion in the cortical and subcortical regions of the occipital, temporal, frontal, and parietal lobes with leptomeningeal and some patchy adjacent parenchymal enhancement with mild sulcal compression and no MRA (not shown) abnormalities. She was restarted on HAART and finished a 3-week course of acyclovir followed by suppressive therapy. Follow-up MR imaging 1 year later (E–H) shows a marked decrease in FLAIR (E and F) high-signal abnormalities with concomitant atrophy and near resolution of the leptomeningeal and parenchymal areas of enhancement, shown on axial contrast images (G and H).