This is a 40-year-old male, diagnosed with HIV 4 years ago, on antiretroviral therapy (Efavirenz 600 mg daily and Emtricitabine/ tenofovir 200/245 mg daily). He had 5-months history of headache and mild unsteadiness, not associated with nausea or vomiting. He presented on 15th of September 2016 to a peripheral hospital with recurrent prolonged seizures. The seizures were aborted with Benzodiazepine. The patient was intubated, sedated and transferred to Neuro critical care unit at King Abdullah Medical City. Upon arrival, his neurological examination was limited due to full sedation but noted to have bilateral papilledema and no obvious localizing signs or meningeal irritation (Figure 1). Plain CT brain showed a fairly symmetrical bilateral basal ganglionic and thalamic hypodensity.