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Cerebrovascular disease in AIDS: a case-control study
J R Berger1, J O Harris, J Gregorios
1Department of Neurology, University of Miami School of Medicine, Florida 33151.
Insights
Stroke incidence in patients with acquired immunodeficiency syndrome (AIDS) was similar to controls. However, cerebral vasculitis was unique to AIDS patients, indicating diverse stroke causes in this population.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Acquired immunodeficiency syndrome (AIDS) can present with various neurological complications.
- Cerebrovascular disease is a significant concern in patients with advanced HIV infection.
- Understanding the spectrum of cerebrovascular and cardiovascular diseases in AIDS is crucial for diagnosis and management.
Purpose of the Study:
- To determine the incidence and spectrum of cerebrovascular and associated cardiovascular diseases in adult patients with AIDS.
- To compare cerebrovascular disease rates in AIDS patients versus a control group of young adults without AIDS.
- To identify specific causes of stroke in the context of AIDS.
Main Methods:
- Retrospective review of autopsy records (1983-1987) from adult patients with AIDS.
- Detailed examination of clinical records for AIDS patients diagnosed with cerebrovascular disease.
- Comparison with autopsy records of adult patients (ages 20-50) dying without AIDS during 1986-1987.
Main Results:
- Cerebrovascular disease was found in 8% of AIDS patients (13/154) versus 23% in controls (25/111), a statistically significant difference (P < 0.04).
- Cerebral vasculitis was exclusively observed in AIDS patients.
- Significant cardiac disease (40%) and cerebral emboli (in 4/13 stroke patients) were noted in AIDS patients.
Conclusions:
- Stroke is not more common in AIDS patients than in a comparable control group.
- The causes of stroke in AIDS are diverse, including cardiac emboli, cerebral hemorrhage, and cerebral vasculitis.
- Cerebral vasculitis is a distinct cerebrovascular complication associated with AIDS.
Abstract:
The autopsy records of adult patients dying with AIDS between 1983 and 1987 at a large, metropolitan, university-affiliated hospital were reviewed to determine the incidence and spectrum of cerebrovascular and associated cardiovascular disease. The clinical records of those patients with AIDS with cerebrovascular disease were retrospectively examined in detail. All autopsied patients between the ages of 20 and 50 years dying without AIDS in 1986 and 1987 served as the control group. At autopsy, 13 (8%) of 154 adult patients with AIDS had evidence of recent cerebrovascular disease. In comparison, 25 (23%) of the 111 control patients dying without AIDS had recent cerebrovascular disease (P less than 0.04). The spectrum of cerebrovascular diseases was similar in patients both with and without AIDS; however, cerebral vasculitis was observed only in the former. Thirty-nine (40%) of 97 patients with AIDS had significant cardiac disease, and cerebral emboli were demonstrated in four of the 13 patients with stroke. Stroke must be considered in the differential diagnosis of neurological disease in patients with AIDS, although it does not appear to be more common in this group than in a control population of young adults with other terminal illnesses. The causes of stroke occurring with AIDS are diverse and include cerebral emboli secondary to cardiac disease, cerebral hemorrhage secondary to thrombocytopenia, and cerebral vasculitis.