Spontaneous artery dissection in a patient with Human Immunodeficiency Virus (HIV) infection

Abstract

-B a c k g round:The relationship between human immunodeficiency virus infection and stro k e may be attributed in some cases to an underlying vasculopathy such as in spontaneous cervical arteries diss e c t i o n s . Case re p o rt: We re p o rt the case of an HIV-infected patient who developed a Wa l l e m b e rg 's synd rome due to a vertebral art e ry dissection. Screening laboratory exams showed hyperh o m o c y s t e i n e m i a and also high C-reactive protein plasma levels. Conclusions: This is the first case describing the association between arterial dissection (AD) and HIV-infection. We suggest that AD should also be remembered as a possible mechanism of ischemic stroke in HIV-infected patients.KEY WORDS: HIV, stroke, vertebral artery dissection.Dissecção arterial espontânea em paciente com infecção pelo HIV RESUMO -I n t rodução: A relação entre AVC e infecção pelo vírus da imunodeficiência humana (HIV) pode ser atribuída em alguns casos a uma vasculopatia subjacente, assim como ocorre nas dissecções art e r i a i s c e rvicais espontâneas. Relato do caso: Relatamos o caso de um paciente com infecção pelo HIV que desenvolveu uma síndrome de Wa l l e m b e rg devido a dissecção da artéria vertebral. Os exames laboratoriais re v elaram aumento da homocisteina sérica e proteína C reativa. Conclusão: Este é o primeiro caso na literatura descrevendo a associação entre dissecção arterial e infecção pelo HIV. Sugerimos que o diagnóstico de dissecção arterial deve ser lembrado como um possível mecanismo de AVC isquêmico em pacientes com infecção pelo HIV. PALAVRAS-CHAVE: HIV, AVC, dissecção artéria vertebral.C u rrent evidence supports the relationship between human immunodeficiency virus (HIV) infection and stroke, although the exact neuropathology of this association is not fully understood 1 -5 . Spontaneous c e rvical arteries dissections (sCAD) are thought to be related to an underlying structural defect of the art erial wall, although the exact type of arteriopathy remains obscure in most cases. Increased plasma homocysteine levels were observed in patients with sCAD when compared to athero t h rombotic strokes. A recent history of a re s p i r a t o ry tract infection is also a risk factor for spontaneous carotid and vertebral arteries dissection. The possibility of an infectious trigger is supported by the seasonal variation in the incidence of sCAD 6 . The relationship between HIV-re l a ted vasculopathy, carotid or vertebral art e ry dissections has not been described yet.We re p o rt a case of an HIV-infected patient who developed a Wa l l e m b e rg 's syndrome due to a vert ebral artery dissection. CASEA 50-year-old white man was admitted to our hospital with a three-day history of sudden ri ght-sided neck pain initiated during physical eff o rt. The cervical pain was followed by an ipsilateral pulsatile parie tal headache. Fort y minutes before admission he was also complaining of right a rm and leg weakness, constant fallings and difficulty in swallowing. He had HIV-infection diagn...

A rare cause of myocardial infarction and ventricular tachycardia in a young male with HIV/AIDS - spontaneous coronary artery dissection: A case report

“… 6 Another report of stroke in HIV due to right vertebral artery dissection has been described. 7 Arteriopathy in HIV can occur due to multiple reasons like HIV related vasculopathy, anti-retro viral therapy etc. Whether there is an interplay between HIV associated inflammation and arteriopathy leading to SCAD is difficult to establish but such a possibility should be considered.…”

Bilateral Epidural Hematoma In A Patient With Human Immunodeficiency Virus (HIV) Infection: A Case Report

“…[10] HIV ile ilişkili vaskülopatide vasküler lezyonlar küçük damarlarda hiyalin kalınlaş-ma, perivasküler alanda gevşeme ve neticesinde perivasküler yoğunluk ve basıncın azalması, damar duvarında mineralizasyon ve pigment birikimi, vaskülit için tanımlayıcı kanıt olmamakla birlikte perivasküler enflamatuvar hücre infiltrasyonu ile karakterizedir. [11] Bu vasküler değişiklikler, yaşlı, diyabetli ve hipertansiyonlu hastalardaki serebral aterosklerotik değişiklik-lere çok benzer. [12] AIDS hastalarında sıklıkla damar değişikliklerine sebep olabilen oportünist enfeksiyon etkenleri ise tüberküloz, toksoplazmoz, aspergilloz, Varisella zoster virüsü, Herpes simpleks, Sitomegalovirüs, hepatit B, sifiliz, kriptokokoz ve kandidiyazistir.…”

Case Report: Spontaneous Carotid Artery Dissection in an HIV Infected Patient

“…In the past medical history, he was HIV positive in regular treatment with Tenofovir, Lamivudine and Efavirenz. His last viral load was undetectable and his CD4 lymphocyte percentage count was 887 [2]. He was started on aspirine and admitted for investigation.…”