Subject(s)
AIDS Arteritis, Central Nervous System/drug therapy , Carotid Stenosis/drug therapy , Glucocorticoids/pharmacology , AIDS Arteritis, Central Nervous System/complications , AIDS Arteritis, Central Nervous System/diagnosis , Adult , Carotid Stenosis/diagnosis , Carotid Stenosis/etiology , Glucocorticoids/administration & dosage , Humans , Magnetic Resonance Imaging , Male , Methylprednisolone/pharmacologyABSTRACT
Neuropathic pain is difficult to treat. Recommended first-line treatments include tricyclic antidepressants and alpha2delta agonists pregabalin and gabapentin for multiple neuropathic conditions, the antidepressants duloxetine and venlafaxine in diabetic painful neuropathies and lidocaine patches for postherapetic neuralgia. Therapeutic prospects include focal therapy with sustained analgesic efficacy (capsaicin patches, botulinum toxin), treatments acting on new targets (i.e., cytokine inhibitors, metabotropic glutamate inhibitors, TRPV1 antagonists). The methodology of clinical trials also tends to take better into account the symptomatic profiles of patients, which should contribute to better prediction or responders to treatment.
Subject(s)
Analgesia/trends , Analgesics/therapeutic use , Neuralgia/therapy , AIDS Arteritis, Central Nervous System/drug therapy , Analgesia/methods , Antidepressive Agents/therapeutic use , Humans , Models, Biological , Neuralgia/drug therapy , Neuralgia/etiology , Pharmaceutical Preparations , Practice Guidelines as Topic , Radiculopathy/drug therapySubject(s)
AIDS Arteritis, Central Nervous System/drug therapy , Antiretroviral Therapy, Highly Active , AIDS Arteritis, Central Nervous System/pathology , Cognition Disorders/etiology , Cognition Disorders/psychology , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged , Perceptual Disorders/etiology , Perceptual Disorders/psychology , Viral LoadABSTRACT
Angiitis of the central nervous system (CNS) in patients infected with HIV-1-is often associated with concomitant infection or lymphoproliferative disease of the CNS. Four HAART naïve patients infected with HIV-1 with severe stroke are described. Evidence of vasculitis was found by magnetic resonance angiography. Extensive investigations excluded concomitant opportunistic, lymphoproliferative or autoimmune disorders leading to the diagnosis of primary angiitis of the CNS. Despite initiation of HAART and prolonged suppression of viral replication, these patients remained severely immunosuppressed. The addition of corticosteroids led to a significant improvement of clinical symptoms. Primary angiitis of the CNS should be considered in patients with HIV and stroke. The prognosis of these patients remain poor despite HAART. These observations suggest that the vascular inflammatory process persists despite the control of viral load under HAART in patients with persistent immunosuppression.
Subject(s)
AIDS Arteritis, Central Nervous System , Antiretroviral Therapy, Highly Active , Central Nervous System Diseases/complications , HIV Infections/complications , Stroke/complications , AIDS Arteritis, Central Nervous System/diagnostic imaging , AIDS Arteritis, Central Nervous System/drug therapy , AIDS Arteritis, Central Nervous System/immunology , AIDS Arteritis, Central Nervous System/virology , Adrenal Cortex Hormones/therapeutic use , Adult , CD4 Lymphocyte Count , Central Nervous System Diseases/diagnostic imaging , Central Nervous System Diseases/drug therapy , Central Nervous System Diseases/immunology , Cerebrum/blood supply , Cerebrum/diagnostic imaging , Cerebrum/virology , Female , HIV Infections/drug therapy , HIV Infections/immunology , HIV Infections/pathology , HIV Infections/virology , HIV-1/drug effects , HIV-1/pathogenicity , Humans , Immunosuppression Therapy , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged , RadiographyABSTRACT
We report a case of HIV-associated carotid vasculitis, causing cerebral infarction. Immediate corticosteroid treatment was followed by improvement, with radiological documentation of reversal of the vasculitic changes, preventing arterial occlusion. Vasculitis should be considered as a diagnosis in stroke in HIV and steroid treatment considered as a potentially life-saving intervention.
Subject(s)
AIDS Arteritis, Central Nervous System/drug therapy , Arterial Occlusive Diseases/prevention & control , Carotid Artery Diseases/drug therapy , HIV Infections/complications , Vasculitis/drug therapy , AIDS Arteritis, Central Nervous System/diagnosis , Adrenal Cortex Hormones/therapeutic use , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Cerebral Infarction/diagnosis , Cerebral Infarction/drug therapy , Cerebral Infarction/etiology , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Treatment Outcome , Vasculitis/diagnosisABSTRACT
BACKGROUND: Moyamoya disease is an occlusion of the terminal portion of internal carotid arteries and proximal portion of middle and anterior cerebral arteries of unknown origin. Moyamoya syndrome is associated with meningitis, tuberculosis, syphilis, head trauma, head irradiation, brain tumor, von Recklinghausen's disease, tuberous sclerosis, Marfan syndrome, sickle cell anemia, arteriosclerosis, hypertension, and oral contraceptive use. To our knowledge, acquired immunodeficiency syndrome (AIDS) as a cause of moyamoya syndrome has not been reported in an adult population. OBJECTIVE: We report a case of moyamoya syndrome in a patient with AIDS and without other conditions associated with occlusion of the circle of Willis and formation of collateral network at the base of the brain and basal ganglia. METHODS: We present a case report. RESULTS: A 29-year-old woman with an 8-year history of AIDS on multiple antiretroviral medications presented with recurrent tingling of the left extremities which 1 month later progressed to mild hemiparesis and dysarthria. During the next few months the patient developed progressive cognitive decline and on-and-off fluctuations in the degree of hemiparesis. Brain magnetic resonance imaging showed multiple small subcortical infarct's in both parietal lobes. Magnetic resonance angiography showed occlusion of middle cerebral arteries distal internal carotid arteries, with prominent collateral network. Cerebral angiography confirmed moyamoya pattern. Lumbar puncture showed: white blood cell count 1, red blood cell count 418, protein 56, glucose 53, negative bacterial and acid-fast bacilli smear and culture, negative VDRL test, India ink, cryptococcal antigen, cytology and negative polymerase chain reaction for cytomegalovirus, Epstein-Barr virus, varicella-zoster virus, and herpes simplex virus type 1 and 2. Electroencephalography showed diffuse background slowing. CONCLUSIONS: We hypothesize that human immunodeficiency virus (HIV) caused central nervous system vasculitis, which eventually led to formation of moyamoya pattern. No other definite causes of central nervous system vasculitis were found in our patient. Cerebrovascular disorders should be considered in patients with HIV/AIDS with focal neurologic deficit. Moyamoya syndrome as a cause of stroke should be considered in patients with HIV/AIDS, especially as survival improves.