Cerebral aneurysmal dilatation in an infant with perinatally acquired HIV infection and HSV encephalitis

Abstract

-Although most children with human immunodeficiency virus (HIV) infection have neurological dysfunction, in childhood the incidence of symptomatic cerebrovascular disease is low. Cerebral aneurysmal arteriopathy in childhood AIDS has been reported in the past and considered to have a relatively long latency following the primary infection. We report a 1 month-old infant with congenitally acquired HIV infection, and herpes encephalitis; she presented a sudden cardiorespiratory arrest followed by coma and was found to have a giant saccular aneurysm of the left basilar artery. Literature review showed that cerebral aneurysmal artheriopathy is an unusual manifestation in newborns and infants and this case is possibly the youngest patient reported with aneurysma, herpes encephalitis and AIDS. The role of HIV and herpes simplex infections in the pathogenesis of this lesion is discussed.KEY WORDS: AIDS, herpes simplex, cerebrovascular disease, infancy.Aneurisma cerebral sintomático precoce em lactente com infecção congênita por HIV e encefalite herpética RESUMO -A maioria das crianças com síndrome da imunodeficiência adquirida (SIDA) apresenta complicações neurológicas, mas a incidência de doença cerebrovascular sintomática nesta faixa etária é baixa. Existem relatos prévios de arteriopatia aneurismática em crianças com SIDA, mas a latência entre a infecção primária e o desenvolvimento dos sintomas geralmente é longa. Relatamos lactente com infecção congênita por HIV, que apresentou encefalite herpética e apresentou subitamente parada cardiorespiratória, seguida de coma. A investigação através de neuroimagem demonstrou aneurisma sacular gigante da artéria basilar. A revisão da literatura demonstra ser a arteriopatia aneurismática uma entidade rara no perído neonatal e em lactentes, sendo possivelmente este o caso mais jovem até o presente relatado com doença cerebrovascular aneurismática associada a herpes e SIDA. A relação da associação entre SIDA e infecção por herpes vírus na gênese da doença cerebrovascular é discutida.

Stroke Caused by Human Immunodeficiency Virus–Associated Intracranial Large-Vessel Aneurysmal Vasculopathy

“…1 In addition, childhood HIV-associated intracranial aneurysmal vasculopathy has been described. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] This report describes an adult HIV-infected woman who had a cerebral infarct caused by aneurysmal dilatation of the arteries in the circle of Willis. To the best of our knowledge, this is the first description of HIV-associated intracranial aneurysmal vasculopathy in an adult with postmortem histopathology.…”

Cerebrovascular disease in children with HIV‐1 infection

“…Both fusiform or saccular aneurysms of the major vessels in the circle of Willis are described . Affected patients with a large aneurysm are at risk of both subarachnoid haemorrhage and ischaemic stroke if thrombus forms within the aneurysm . Massive fusiform dilatation of the vessels of the circle of Willis is associated with high viral load, and progress is arrested or reversed with initiation of ART .…”

“…Twenty-seven case reports and series (including four autopsy studies) and four larger patient cohorts 2,[36][37][38] (inclusive of children with cerebrovascular disease) were identified. In total, there were 74 cases of cerebrovascular disease in children infected with HIV reported to date from North and Central America (USA, Mexico), [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]37,38 South America (Columbia, Brazil), [26][27][28][29] Europe (Netherlands, France, Germany), [30][31][32] Africa (South Africa, Ethiopia), 2,36 and Asia (India, Thailand). [33][34][35] Most reports were from the USA and reported before 2002.…”

Intracranial vascular complications in AIDS

“…У 36,4% больных детей и 37,5% взрослых пациентов до диагностики аневризм имели место инфаркты мозга. Наличие аневризмы у 45% пациентов детского воз-раста и 25% взрослых не сопровождалось ишемией и геморрагией [43,[53][54][55][56][57][58][59][60][61][62].…”