Two Cases of Cerebral Aneurysms in HIV+ Children

Fulmer, Benjamin B.; Dillard, Stephanie C.; Musulman, Elizabeth M.; Palmer, Cheryl A.; Oakes, Jerry

doi:10.1159/000028615

Cited by 61 publications

(45 citation statements)

References 9 publications

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“…In addition to aneurysms, fibrosis, vasculitis, and calcification were all observed. 24 Thus, by the mid-1980s a number of additional developments had occurred that were important in pediatric aneurysms. 1) Microsurgical techniques had been developed, disseminated, and recognized as far superior to conventional neurosurgical techniques.…”

Section: Neurosurg Focus / Volume 20 / June 2006mentioning

confidence: 99%

History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms

Blount

Oakes

Tubbs

et al. 2006

FOC

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✓ Intracranial aneurysms are rare in children, and their origins and treatment methods tend to be different from those in these same entities in adults. These lesions tend to be congenital or to have an infectious or traumatic origin. In the current paper the authors trace the historical evolution of the diagnosis and treatment of intracranial aneurysms in children. Based on the literature, these lesions appear to occur in children in less than 3% of all series. The literature also supports the suggestion that symptoms from these aneurysms are often from mass effect and that giant aneurysms and lesions in the posterior cranial fossa are relatively more common in children than in adults. The termination of the carotid artery and the anterior cerebral artery seem to be disproportionately common sites of aneurysm formation in this cohort. Interestingly, surgical outcomes in children appear to be moderately better than in adults. Based on the literature, the claim can be made that a multidisciplinary approach to the management of such aneurysms can yield good outcomes in a very high percentage of children treated.

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Section: Neurosurg Focus / Volume 20 / June 2006mentioning

confidence: 99%

History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms

Blount

Oakes

Tubbs

et al. 2006

FOC

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“…Arteriopatia na AIDS tem sido reconhecida cada vez mais e uma parcela de crianças HIV positivas evo-luem com infartos e/ou hemorragias 6,11 . Em pacientes infectados pelo HIV, aneurismas de artérias cerebrais podem se desenvolver como uma manifestação não usual da doença vascular associada ao HIV, a angiopatia de artérias de grande calibre do SNC, sem o envolvimento de pequenos vasos 9 .…”

Section: Casounclassified

“…Em ambos os casos, o polígono de Willis foi afetado em múltiplas áreas por dilatação aneurismática fusiforme 11 .…”

Section: Casounclassified

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Aneurisma de artéria cerebral em criança com síndrome da imunodeficiência adquirida: relato de caso

Neto

Bruck

Coelho

et al. 2001

Arq. Neuro-Psiquiatr.

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RESUMO -A dilatação aneurismática dos vasos do polígono de Willis é manifestação incomum da infecção pelo vírus da imunodeficiência adquirida (HIV), tendo sido relatados, até o momento, 15 casos na literatura. O presente estudo tem por objetivo relatar um novo caso dessa apresentação rara, além de revisar aspectos importantes relacionados à mesma. Um paciente, do sexo masculino, 6 anos de idade, com síndrome da imunodeficiência adquirida (AIDS) de transmissão perinatal e tetraparesia, desenvolveu sintomas caracterizados por episódios de crises distônicas. A tomografia computadorizada de crânio, que inicialmente era normal, mostrou dilatação aneurismática dos vasos do polígono de Willis. A revisão de literatura demonstra que os principais achados patológicos em casos similares, são, principalmente, fibrose de camada média com destruição da lâmina interna e hiperplasia da íntima. A etiologia da vasculite não é conhecida, acreditando-se que o vírus da varicela-zoster e o próprio HIV possam estar relacionados à mesma. Conclui-se que, apesar de incomum, tal complicação apresenta grande importância pelo fato dos aneurismas colocarem esses pacientes em grupo de alto risco para acidentes vasculares. A sobrevida relatada na literatura é de menos de 6 meses após o diagnóstico da arteriopatia aneurismática cerebral. PALAVRAS-CHAVE: AIDS, perinatal, arteriopatia aneurismática, polígono de Willis. Cerebral arterial aneurysm in a child with acquired immunodeficiency syndrome: case reportABSTRACT -Cerebral aneurysmal arteriopathy of the circle of Willis is an uncommon manifestation of acquired human immunodeficiency virus (HIV) infection and up to now only 15 cases have been published in the literature. For this reason we add our experience of this rare case, and review the most important aspects related to this entity. The patient is a 6 year old male with perinatal transmitted AIDS, tetraparethic, developed symptoms characterized by episodes of dystonic postures. The computed tomography of the brain showed aneurismal arteriopathy of the circle of Willis. He had a previous normal examination. The review of the literature shows the pathological abnormalities of the affected vessels are mainly medial fibrosis, with destruction of the internal elastic lamina and intimal hyperplasia. The etiology for the vasculitis is unknown. Varicela zoster virus, as well as HIV by itself, can be related to the physiopathology of the vasculitis. On conclusion, it can be said that although uncommon, such complications are of great importance by the fact that the patients with vascular aneurismal arteriopathy are in high risk for vascular accidents, and once a diagnosis was made, death occurs in less than 6 months, according to the literature.

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“…Two patients had multiple fusiform aneurysmal dilatations of the circle of Willis manifesting as SAH and cerebral infarction. 3) Another patient had spontaneous SAH induced by thrombocytopenia but cerebral angiography failed to show any vascular malformation. Thrombocytopenia could have been the major factor in the pathogenesis of the hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage in a Patient With Human Immunodeficiency Virus Type 1 Infection-Case Report-

Miyamoto

Hara

Tabei

et al. 2006

Neurol. Med. Chir.(Tokyo)

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A 54-year-old human immunodeficiency virus type 1 (HIV-1)-infected homosexual Japanese male was found to have collapsed in his bathroom and was brought to our facility with diminished level of consciousness. Computed tomography showed subarachnoid hemorrhage (SAH). He was severely dehydrated with unstable general status that deterred us from performing emergent surgery. Cerebral angiography performed on the 18th hospital day revealed bilateral distal anterior cerebral artery aneurysms. Clipping of these aneurysms was performed on the 30th hospital day and no postoperative complications were experienced. The scalp wound showed no delayed healing, whereas the tracheostomy wound showed repeated wound dehiscence and delayed healing. Postoperative highly active antiretroviral therapy with antibiotic treatment gradually improved his general and immunological conditions. The patient was finally discharged as independent with mild muscle weakness in the bilateral lower extremities. HIV-1 infection should not be the guiding factor in the decision to aggressively treat concomitant aneurysmal disease. Clipping of cerebral aneurysms with full craniotomy or endovascular obliteration should be considered even in HIV-1-infected patients with SAH.

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Two Cases of Cerebral Aneurysms in HIV+ Children

Cited by 61 publications

References 9 publications

History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms

History of surgery for cerebrovascular disease in children. Part I. Intracranial arterial aneurysms

Aneurisma de artéria cerebral em criança com síndrome da imunodeficiência adquirida: relato de caso

Aneurysmal Subarachnoid Hemorrhage in a Patient With Human Immunodeficiency Virus Type 1 Infection-Case Report-

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