De Novo intracerebral aneurysm in a child with acquired immunodeficiency syndrome.

Human immunodeficiency virus (HIV) infection associated aneurysmal vasculopathy is a rare complication of HIV infection affecting the pediatric and adult population. We present a case of a 7-year-old male child known to have a congenitally acquired HIV infection presenting with a ruptured left distal internal carotid artery fusiform aneurysm that was diagnosed on MRI scans 6 months prior to his presentation. He underwent craniotomy and successful aneurysm reconstruction. He had uncomplicated postoperative course and experienced a good recovery. This case is among the few reported pediatric cases of HIV-associated cerebral arteriopathy to undergo surgery. We also reviewed the relevant literature of this rare condition.

Primary vasculitis of the central nervous system in patients infected with HIV-1 in the HAART era.

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.

Cerebrovascular disease in HIV-infected pediatric patients: neuroimaging findings.

OBJECTIVE: The goal of our study was to report on the prevalence and the neuroradiologic manifestations of cerebrovascular complications in children infected with HIV. We also elucidate the types of vascular involvement, identify their anatomic distribution, and discuss possible causes. MATERIALS AND METHODS: We conducted a retrospective study of 567 patients (age range, 1 month-29 years; median age, 5.47 years) who acquired HIV as children. Of these, 426 patients (75%) were evaluated with neuroimaging studies. We reviewed these studies to identify the cerebrovascular abnormalities and classify them by type, anatomic location, and shape. RESULTS: Eleven children (2.6%) were found to have cerebrovascular lesions. Only one had focal neurologic symptoms at the time of diagnosis. Twenty-six aneurysms were found in seven patients, and 27 infarctions were found in eight patients. In four of the patients with infarctions, fusiform aneurysms of the cerebral arteries were also identified. Most patients had advanced HIV disease. Nine of the 11 patients were infected by a vertical transmission route or during blood transfusion early in the neonatal period. In this group of patients, the diagnosis of cerebrovascular disease was made earlier (mean age at diagnosis, 8.2 years) than in the two patients who were infected later in life (mean age at diagnosis, 14.9 years). CONCLUSION: HIV-infected children have an increased incidence of cerebrovascular disease that is associated with severe immune suppression and with vertically acquired HIV infection or exposure to the virus in the neonatal period. Despite extensive lesions, most children in our study were asymptomatic. Screening with MR imaging should be considered for high-risk children and is advisable when evidence of neurologic symptoms or neurocognitive dysfunction is noted.