Recognizing the MRI characteristics of progressive multifocal leukoencephalopathy is essential for early diagnosis. This report describes the oldest known case of an 83-year-old man with rapidly progressive dementia and HIV-associated classic PML. Brain MRI revealed hallmark findings, including asymmetric, continuous, non-enhancing subcortical lesions in the parietooccipital regions and the "shrimp sign" in the cerebellar white matter.
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