I saw the "Milky Way sign" and the "Barbell sign" in the same patient.

The Milky Way sign is characterized by multiple punctate lesions, with hyperintense signal on T2-weighted imaging, with no restricted diffusion and usually no gadolinium-enhancement. The Barbell sign is seen as a lesion extending across the splenium of the corpus callosum, with hyperintense signal on T2-weighted imaging with no or minimal mass effect, no gadolinium-enhancement, and no restricted diffusion or only a thin rim of peripheral restricted diffusion. Although these signs have differential diagnoses, in the correct clinical setting, they are suggestive of progressive multifocal leukoencephalopathy (PML). In this article, we present a case of PML in a man with a recent diagnosis of human immunodeficiency virus infection, who was not using antiretroviral therapy, and presented with both the Milky Way sign and the Barbell sign on a brain magnetic resonance imaging.