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Stroke and cerebral infarcts in children infected with human immunodeficiency virus
P Philippet1, S Blanche, G Sebag
1Service of Pediatric Immunology and Hematology, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Stroke and cerebral infarcts in children with human immunodeficiency virus (HIV) have varied causes and outcomes. This study examined four pediatric cases, revealing different underlying pathologies and prognoses in HIV-infected children.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroscience
Background:
- Stroke and cerebral infarcts are serious complications in children.
- Human immunodeficiency virus type 1 (HIV-1) infection can affect the central nervous system.
- Understanding the specific causes of cerebrovascular events in HIV-1-infected children is crucial for management.
Observation:
- A case series of four HIV-1 infected children with stroke and cerebral infarcts was analyzed.
- Patients presented with diverse clinical statuses and outcomes despite severe immunodepression.
- Cerebral artery aneurysms, thrombosis, and HIV-1-related focal necrosis were identified as potential causes.
Findings:
- Two patients experienced aneurysmal dilation and/or thrombosis of cerebral arteries, associated with frequent infections and poor outcomes.
- One patient had isolated cerebrovascular thrombosis with a more favorable prognosis.
- Another patient showed signs of HIV-1-related focal necrosis without vascular abnormalities, suggesting a different pathogenic mechanism.
Implications:
- Cerebrovascular complications in HIV-1 infected children are multifactorial.
- The diverse etiologies necessitate individualized diagnostic and therapeutic approaches.
- Further research is needed to elucidate the precise mechanisms and improve outcomes for these children.
Objective:
To study the causes of stroke and cerebral infarcts in children infected with the human immunodeficiency virus (HIV)-type 1.
Design:
Case series.
Patients:
Four of 380 HIV-infected children followed up in a 10-year period in our department who had a stroke with evidence of cerebral infarcts on radiological imaging.
Results:
The four patients were severely immunodepressed, but their clinical status and outcome were different. Aneurysmal dilation of major cerebral arteries and thrombosis of these arteries or of small cortical vessels were discovered in two patients. Both patients had a history of frequent infections and had suffered repeated neurological events that resulted in severe clinical deterioration or death. An infectious causative agent was strongly suspected but was not detected. The other two patients had a more favorable outcome. An isolated cerebrovascular thrombosis was found in one patient, while in the other, HIV-1-related focal necrosis was suggested by the lack of permanent cerebrovascular abnormalities or thrombosis and by signs of necrosis in biopsy specimens of the brain.
Conclusion:
Stroke and cerebral infarcts in HIV-1 infected children have different causes and different prognoses.