MRI in human immunodeficiency virus-associated cerebral vasculitis

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Cerebral ischemia from inflammatory vasculopathies is a known complication of human immunodeficiency virus (HIV) infection.
• Previous imaging studies identified ischemic lesions and vascular lumen changes but could not visualize vessel wall abnormalities.

Observation:

• Two HIV-infected men presented with transient ischemic attack symptoms.
• Initial MRI scans showed no infarct in the first patient and two small lacunar lesions in the second.
• Contrast-enhanced T1-weighted MRI revealed aneurysmal dilatation and wall thickening/enhancement of the internal carotid and middle cerebral arteries in both patients.

Findings:

• The MRI findings were indicative of cerebral vasculitis.
• The first patient experienced carotid artery occlusion and a middle cerebral artery (MCA) territory infarct, but stabilized neurologically.
• Varicella zoster virus (VZV) infection was the suspected cause of vasculitis in the second patient.

Implications:

• Advanced MRI techniques can detect subclinical cerebral vasculitis in HIV patients.
• Prompt diagnosis and treatment with antiviral and immunosuppressive therapy can lead to regression of vasculitic changes and clinical improvement.
• Understanding the role of VZV in HIV-associated vasculitis warrants further investigation.