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Stroke in pediatric acquired immunodeficiency syndrome
Y D Park1, A L Belman, T S Kim
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461.
Annals of Neurology
|September 1, 1990
Summary
Pediatric stroke is a concern in children with human immunodeficiency virus (HIV) infection. Autopsy findings reveal a higher prevalence of cerebrovascular disease than clinically diagnosed, suggesting stroke should be considered in these patients.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Longitudinal study investigating neurological complications in children with human immunodeficiency virus (HIV) infection.
- Assessed clinical incidence of stroke over a 4.5-year period.
Observation:
- Four of 68 children exhibited clinical and/or neuroradiological evidence of stroke.
- Autopsy data from 18 of 32 deceased children, including 3 with clinical stroke, revealed a higher prevalence of cerebrovascular pathology.
- Cerebrovascular disease was found in 24% of HIV-infected children at autopsy.
Findings:
- Intracerebral hemorrhages (4), nonhemorrhagic infarcts (6), and combined lesions (3) were observed.
- Hemorrhagic stroke was catastrophic in one child and clinically silent in three with immune thrombocytopenia.
- Arteriopathy, aneurysm dilation of the circle of Willis, and coexisting cardiomyopathy with necrotizing encephalomyelomyelopathy were noted.
Implications:
- Stroke should be considered in the differential diagnosis for children with HIV infection presenting with focal neurological deficits.
- Autopsy findings highlight the underdiagnosis of cerebrovascular disease in this population.
- Further research into the mechanisms and management of stroke in pediatric HIV is warranted.