HIV-associated cavernous sinus disease

Area of Science:

• Neurology
• Infectious Diseases
• Oncology

Background:

• Cavernous sinus disease diagnosis is challenging in HIV-coinfected patients due to lack of histological confirmation.
• This study highlights diagnostic and management challenges in this population.

Purpose of the Study:

• To analyze clinical, laboratory, and radiological data of HIV-infected patients with cavernous sinus disease.
• To identify common causes and diagnostic challenges.
• To guide management strategies in resource-limited settings.

Main Methods:

• Retrospective case series analysis.
• Review of clinical, laboratory, and radiological data from 23 HIV-infected patients.
• Analysis of diagnostic methods, including biopsy and cerebrospinal fluid examination.

Main Results:

• Common presentations included unilateral disease, headache, diplopia, and blurred vision.
• Cranial nerve palsies, particularly third and sixth, were most frequent.
• Tuberculosis, lymphoma, meningioma, metastatic carcinoma, and neurosyphilis were identified causes; 22% lacked confirmatory diagnosis.
• Empirical tuberculosis treatment or spontaneous improvement with antiretroviral therapy (ART) was observed.

Conclusions:

• Histological confirmation of cavernous sinus pathology is often unavailable in HIV patients.
• Prioritize searching for extracranial evidence of tuberculosis, lymphoma, syphilis, and malignancy in resource-limited settings.
• Consider biopsy referral only when other diagnostic evidence is lacking.