Subarachnoid hemorrhage and diffuse vasculopathy in an adult infected with HIV

Case report

Restricted access

✓This 34-year-old man with a 10-year history of HIV infection presented with an acute onset of severe headache, fever, nausea, vomiting, and left-sided weakness. Computed tomography (CT) scanning demonstrated diffuse subarachnoid hemorrhage (SAH), and subsequent CT angiography revealed multiple large and giant intracranial aneurysms with diffuse vasculopathy. The patient's CD4-positive cell count was low, although he had been receiving combination antiret-roviral therapy and his viral load was undetectable.

The preponderance of the literature on HIV-infected patients with intracranial vascular involvement has concerned children in whom there is a high viral load. In such children, appropriate antiretroviral therapy may result in the complete resolution of these vascular abnormalities. In the present study, the authors report on the unique case of an HIV-infected adult patient who presented with SAH, diffuse intracranial vasculopathy, and multiple giant and fusiform aneurysms, despite having received adequate antiretroviral treatment and demonstrating an undetectable viral load. Intracranial vascular involvement in these patients may become increasingly common as the management of HIV infection continues to improve and afflicted patients survive for longer periods.

Abbreviations used in this paper:CT = computed tomography; SAH = subarachnoid hemorrhage.

Article Information

Address reprint requests to: Aaron S. Dumont, M.D., Box 800212, Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908. email: asd2f@virginia.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Unenhanced CT images of the head showing diffuse SAH. Within the subarachnoid clot, there appears to be negative filling defects suggesting multiple aneurysms of the circle of Willis.

  • View in gallery

    Three-dimensional reconstructions of the CT angiogram. A: Posterior view demonstrating a diffuse irregularity of the basilar artery trunk with multiple areas of vessel wall dilation. Note the absence of the left P1 segment (as there is a fetal origin of the left posterior cerebral artery) and the fusiform appearance of the right posterior cerebral artery. B: Right lateral view revealing fusiform dilations of the right cavernous, supraclinoid, anterior cerebral, and middle cerebral arteries. The right internal carotid artery (RICA) bifurcation and giant anterior communicating artery aneurysms are visualized, and involvement of the left supraclinoid carotid artery can be seen in the background. C: Posterior and superior views showing fusiform dilations of both supraclinoid carotid arteries, anterior cerebral arteries, and middle cerebral arteries, and the left posterior cerebral artery, a giant anterior communicating artery aneurysm, and a giant right carotid artery bifurcation aneurysm. RT-PCOM = right posterior communicating artery.

References

  • 1

    Berkefeld JEnzensberger WLanfermann H: MRI in human immunodeficiency virus-associated cerebral vasculitis. Neuroradiology 42:5265282000

    • Search Google Scholar
    • Export Citation
  • 2

    Bonkowsky JLChristenson JCNixon GWPavia AT: Cerebral aneurysms in a child with acquired immune deficiency syndrome during rapid immune reconstitution. J Child Neurol 17:4574602002

    • Search Google Scholar
    • Export Citation
  • 3

    Bulsara KRRaja AOwen J: HIV and cerebral aneurysms. Neurosurg Rev 28:92952005

  • 4

    Dubrovsky TCurless RScott GChaneles MPost MJAltman N: Cerebral aneurysmal arteriopathy in childhood AIDS. Neurology 51:5605651998

    • Search Google Scholar
    • Export Citation
  • 5

    Elfenbein DSEmmanuel PJ: Radiological case of the month. Aneurysmal dilation of cerebral arteries associated with HIV infection. Arch Pediatr Adolesc Med 155:8498502001

    • Search Google Scholar
    • Export Citation
  • 6

    Fulmer BBDillard SCMusulman EMPalmer CAOakes J: Two cases of cerebral aneurysms in HIV+ children. Pediatr Neurosurg 28:31341998

    • Search Google Scholar
    • Export Citation
  • 7

    Gavin PYogev R: Central nervous system abnormalities in pediatric human immunodeficiency virus infection. Pediatr Neurosurg 31:1151231999

    • Search Google Scholar
    • Export Citation
  • 8

    Husson RNSaini RLewis LLButler KMPatronas NPizzo PA: Cerebral artery aneurysms in children infected with human immunodeficiency virus. J Pediatr 121:9279301992

    • Search Google Scholar
    • Export Citation
  • 9

    Kanmogne GDKennedy RCGrammas P: HIV-1 gp120 proteins and gp160 peptides are toxic to brain endothelial cells and neurons: possible pathway for HIV entry into the brain and HIV-associated dementia. J Neuropathol Exp Neurol 61:99210002002

    • Search Google Scholar
    • Export Citation
  • 10

    Kure KPark YDKim TSLyman WDLantos GLee S: Immunohistochemical localization of an HIV epitope in cerebral aneurysmal arteriopathy in pediatric acquired immunodeficiency syndrome (AIDS). Pediatr Pathol 9:6556671989

    • Search Google Scholar
    • Export Citation
  • 11

    Lang CJacobi GKreuz WHacker HHerrmann GKeul HG: Rapid development of giant aneurysm at the base of the brain in an 8-year-old boy with perinatal HIV infection. Acta Histochem Suppl 42:83901992

    • Search Google Scholar
    • Export Citation
  • 12

    Maniker AHHunt CD: Cerebral aneurysm in the HIV patient: a report of six cases. Surg Neurol 46:49541996

  • 13

    Martinez-Longoria CAMorales-Aguirre JJVillalobos-Acosta CPGomez-Barreto DCashat-Cruz M: Occurrence of intracerebral aneurysm in an HIV-infected child: a case report. Pediatr Neurol 31:1301322004

    • Search Google Scholar
    • Export Citation
  • 14

    Mazzoni PChiriboga CAMillar WSRogers A: Intracerebral aneurysms in human immunodeficiency virus infection: case report and literature review. Pediatr Neurol 23:2522552000

    • Search Google Scholar
    • Export Citation
  • 15

    Nunes MLPinho APSfoggia A: Cerebral aneurysmal dilatation in an infant with perinatally acquired HIV infection and HSV encephalitis. Arq Neuropsiquiatr 59:1161182001

    • Search Google Scholar
    • Export Citation
  • 16

    Patsalides ADWood LVAtac GKSandifer EButman JAPatronas NJ: Cerebrovascular disease in HIV-infected pediatric patients: neuroimaging findings. AJR Am J Roentgenol 179:99910032002

    • Search Google Scholar
    • Export Citation
  • 17

    Petropoulou FMostrou GPapaevangelou VTheodoridou M: Central nervous system aneurysms in childhood AIDS. AIDS 17:2732752003

  • 18

    Ren ZYao QChen C: HIV-1 envelope glycoprotein 120 increases intercellular adhesion molecule-1 expression by human endothelial cells. Lab Invest 82:2452552002

    • Search Google Scholar
    • Export Citation
  • 19

    Shah SSZimmerman RARorke LBVezina LG: Cerebrovascular complications of HIV in children. AJNR Am J Neuroradiol 17:191319171996

    • Search Google Scholar
    • Export Citation
  • 20

    Sinzobahamvya NKalangu KHamel-Kalinowski W: Arterial aneurysms associated with human immunodeficiency virus (HIV) infection. Acta Chir Belg 89:1851881989

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 297 297 72
Full Text Views 98 79 0
PDF Downloads 92 74 0
EPUB Downloads 0 0 0

PubMed

Google Scholar