Aneurysmal Subarachnoid Hemorrhage in a Patient With Human Immunodeficiency Virus Type 1 Infection-Case Report-

Abstract

A 54-year-old human immunodeficiency virus type 1 (HIV-1)-infected homosexual Japanese male was found to have collapsed in his bathroom and was brought to our facility with diminished level of consciousness. Computed tomography showed subarachnoid hemorrhage (SAH). He was severely dehydrated with unstable general status that deterred us from performing emergent surgery. Cerebral angiography performed on the 18th hospital day revealed bilateral distal anterior cerebral artery aneurysms. Clipping of these aneurysms was performed on the 30th hospital day and no postoperative complications were experienced. The scalp wound showed no delayed healing, whereas the tracheostomy wound showed repeated wound dehiscence and delayed healing. Postoperative highly active antiretroviral therapy with antibiotic treatment gradually improved his general and immunological conditions. The patient was finally discharged as independent with mild muscle weakness in the bilateral lower extremities. HIV-1 infection should not be the guiding factor in the decision to aggressively treat concomitant aneurysmal disease. Clipping of cerebral aneurysms with full craniotomy or endovascular obliteration should be considered even in HIV-1-infected patients with SAH.

HIV Infection, Vascular Disease, and Stroke

“…In the pre-cART era, young adults and children with advanced HIV infection were known to develop a cerebral aneurysmal arteriopathy with fusiform dilatation and ectasia of the cerebral vessels, often in the Circle of Willis, with or without SAH. [45][46][47][48][49][50][51][52] Case reports of radiographic stabilization or resolution of aneurysms after initiation of cART 53,54 imply that immunodeficiency may have played a role in the development of these vascular abnormalities. More recently, Durand et al observed an increased adjusted hazard (HR 3.28, 95% CI 1.75-6.12, p < 0.001) of a composite outcome of ICH and SAH in HIV-infected individuals compared with uninfected age-matched controls using two validated medical databases for all residents of Quebec province between 1985-2007.…”

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].…”

Highly Effective Antiretroviral Therapy and Cerebral Aneurysms

“…Until 2006, fusiform dilatations of intracranial arteries have been described in HIV-positive in 32 children 9,14,26,29 , and until 2007 only 11 HIV-positive patients have been described with intracranial aneurysms 17,18,20,29 . Seven of these had saccular aneurysms and one had a giant aneurysm 8,12,14 that could have been coincidental congenital aneurysms.…”

“…Infection with the HIV contributes to an increased risk of stroke 21 , and published series of HIV -positive patients demonstrated an incidence of 6-11% of intracerebral hemorrhage 2,13,17,20,21,22,23,24,27 .…”