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Perinatally HIV-infected youth presenting with acute stroke: progression/evolution of ischemic disease on
Izlem Izbudak1, Majid Chalian, Nancy Hutton
1Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA. iizbuda1@jhmi.edu
Insights
Perinatally HIV-infected youth with stroke show continued cerebrovascular disease progression, often without new symptoms. This highlights the need for vigilant monitoring and evaluation of central nervous system pathology in this growing population.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroradiology
Background:
- Perinatally HIV-infected (PHIV) children are aging, forming a cohort with unique long-term health concerns.
- Acute stroke is an identified risk in PHIV pediatric patients.
- Understanding the evolution of neuroimaging findings in PHIV youth post-stroke is crucial.
Purpose of the Study:
- To evaluate the progression of neuroimaging findings in perinatally HIV-infected youth who initially presented with acute stroke.
- To analyze changes in cerebrovascular disease over time in this specific pediatric population.
Main Methods:
- Retrospective review of medical records for 179 PHIV pediatric patients (1996-2010).
- Inclusion criteria: clinical documentation of acute stroke referred for neuroradiology evaluation.
- Analysis of initial and follow-up neuroimaging (CT, MRI, MRA) and clinical data.
Main Results:
- Eight PHIV patients with acute stroke were identified.
- All patients showed infarction on initial/follow-up imaging (basal ganglia-thalami, cortical, internal capsule).
- Progression of cerebrovascular disease occurred in 7/8 patients, often asymptomatically; Circle of Willis abnormalities and aneurysms were common.
Conclusions:
- Asymptomatic progression of cerebrovascular disease is evident in PHIV adolescents post-stroke.
- These findings necessitate a low threshold for evaluating central nervous system pathology in PHIV youth.
- Further research is needed to determine the benefit of screening for asymptomatic cerebrovascular disease in this population.
Background And Purpose:
Although HIV infection is decreasing in infants and children, there is a steady cohort of perinatally HIV-infected (PHIV) children that are growing older. Increased risk of acute stroke has been reported in PHIV children. Our goal was to evaluate evolution/progression of neuroimaging findings in PHIV youth initially presenting with acute stroke.
Materials And Methods:
The medical records of PHIV pediatric patients (n = 179) from 1996 to 2010 were reviewed and patients with clinical documentation of acute stroke referred to the neuroradiology service were eligible for the study. Neuroimaging (brain CT, MRI, and MRA) and charts were evaluated; clinical and neuroimaging findings at the initial acute stroke and at the last presentation to the neuroradiology service were documented and analyzed.
Results:
Eight PHIV patients with clinical findings of acute stroke referred to the neuroimaging were identified. CT and MRI findings of infarction were found in all (8/8) patients in their first and/or last neuroimaging study; including basal ganglia-thalami (BGT) infarction (7/8), focal cortical infarction (4/8), and internal capsule infarction (4/8). Imaging depicted cortical atrophy (5/8), BGT calcification (3/8), and posterior reversible encephalopathy syndrome, wallerian degeneration, and periventricular white matter hyperintense T2 signal each in one patient. No tumors or infectious masses, cysts or abscesses were identified. Subsequent available neuroimaging revealed progression of the cerebrovascular disease in seven patients, 5/7 in the absence of new clinical signs or symptoms. Segmental occlusion, narrowing or narrowing/dilatation in the circle of Willis was found in 6/6 patients who underwent MR angiography and fusiform aneurysms were detected in three of them, a saccular aneurysm in one patient.
Conclusion:
Asymptomatic progression of cerebrovascular disease was found in PHIV adolescents with prior stroke. These findings may have implications for long-term risk and outcomes for this patient population. There should be a low threshold to evaluate for CNS pathology even with minor symptoms in this population. More studies are necessary to determine if there is a benefit from screening of asymptomatic patients.
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