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Two cases of cerebral aneurysms in HIV+ children
B B Fulmer1, S C Dillard, E M Musulman
1Division of Neurosurgery, University of Alabama at Birmingham, USA.
Insights
Fusiform cerebral aneurysms are rare in children with human immunodeficiency virus (HIV). This report details two pediatric cases, including a novel association with varicella-zoster vasculitis, highlighting management challenges.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Fusiform cerebral aneurysms are uncommon vascular lesions.
- Human immunodeficiency virus (HIV) infection can be associated with various neurological complications, including arteriopathy.
- Pediatric cases of HIV-associated cerebral aneurysms are exceptionally rare.
Observation:
- Two pediatric cases of fusiform cerebral aneurysms in HIV-positive children are presented.
- One case involved an aneurysm associated with varicella-zoster vasculitis, a previously unreported association.
- Presentations included subarachnoid hemorrhage and cerebral infarct with hemiparesis.
Findings:
- One patient experienced a subarachnoid hemorrhage (Hunt-Hess grade IV), requiring complex surgical management, and ultimately succumbed to rebleeding.
- The second patient presented with a cerebral infarct leading to hemiparesis and improved with medical management.
- These cases underscore the diverse clinical manifestations and management difficulties of AIDS arteriopathy in children.
Implications:
- Fusiform cerebral aneurysms in HIV-positive children represent a significant clinical challenge.
- Early recognition and appropriate management strategies are crucial for improving outcomes.
- Further research is needed to understand the pathogenesis and optimize treatment for these rare conditions.
Abstract:
Two cases of fusiform cerebral aneurysms in human immunodeficiency virus (HIV) positive children are presented. To our knowledge, only 9 patients with this association have been reported. One of our patients represents the first report of a patient with an aneurysm associated with varicella-zoster vasculitis. One patient presented with a subarachnoid hemorrhage, Hunt-Hess grade IV, and posed difficult surgical management. The other patient suffered a cerebral infarct with a resulting hemiparesis. The first patient had a ventriculostomy placed, initially improved, and subsequently died from rebleeding. The second patient improved with medical management. AIDS arteriopathy, and specifically fusiform aneurysms, are being increasingly reported. The various presentations of this surgically challenging entity in light of other AIDS-related syndromes pose difficult management decisions. On occasion, the intracranial aneurysm may be the initial form of presentation as was present in our first patient.