Human immunodeficiency virus (HIV)-1-associated neurocognitive disorder can manifest with a variety of neurologic, cognitive, and behavioral impairments. We report a case of a 49-year-old non-HIV risk woman with an occult HIV infection who posed a diagnostic challenge as she suffered from a HIV-1-associated neurocognitive disorder with predominant motor symptoms mimicking upper motor neuron disease. Functional imaging using F-18 fluorodeoxyglucose positron emission tomography provided evidence of involvement of several cerebral regions which exhibited a distinct pattern of relative cerebral hypermetabolism (subcortical, brainstem, and cerebellar regions) and hypometabolism (sensorimotor cortex, mesiofrontal, and mesiotemporal areas) and functionally corresponded to the clinical symptoms. The results of the positron emission tomography scan are discussed in comparison with the current positron emission tomography literature and future perspectives are illustrated.