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Stroke and seizures as the presenting signs of pediatric HIV infection
A Visudtibhan1, P Visudhiphan, S Chiemchanya
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Pediatric stroke and seizures can be the first signs of human immunodeficiency virus (HIV) infection. Early HIV testing is crucial for children presenting with cerebrovascular accidents, especially those at risk.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Human immunodeficiency virus (HIV) infection can manifest with neurological complications in children.
- Cerebrovascular accidents (CVAs), including stroke and seizures, are potential early signs of pediatric HIV.
Observation:
- Two pediatric cases are presented: a 3-year-old female with hemiparesis and a 2-month-old infant with focal seizures.
- Both patients presented with neurological symptoms as the initial manifestation of HIV infection.
Findings:
- Ischemic infarction was identified in the thalamus, hypothalamus, and internal capsule in the first patient, and the cerebral cortex in the second.
- No other causes for the cerebral infarctions were found, and opportunistic central nervous system infections were not documented.
Implications:
- Cerebrovascular accident should be considered an initial presentation of HIV infection in children.
- HIV testing is essential in the diagnostic workup for pediatric stroke, particularly in at-risk populations.
Abstract:
The authors report two pediatric patients with definite human immunodeficiency virus infection whose initial presentation was stroke and seizure. The first patient was a 3-year-old female who developed acute hemiparesis as the first manifestation. The other, a 2-month-old infant, had focal seizures secondary to cerebral infarction. Investigations revealed ischemic infarction of the thalamus, hypothalamus, and internal capsule in the first patient and cerebral cortex in the second. Further investigations failed to demonstrate any other causes of these cerebral infarctions. Opportunistic infection of the central nervous system was not documented. The authors emphasize that cerebrovascular accident may be the initial presentation in human immunodeficiency virus infection in children. Human immunodeficiency virus infection must be included in the differential diagnosis, and testing for the disease is mandatory in the investigation of stroke in any child who is at risk of having this infection.