Abstract
Introduction
As the medical treatment for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) continues to advance, the HIV-related aneurysms may pose a clinical problem of increasing magnitude. The authors report on a successfully treated ruptured mycotic intracavernous carotid artery aneurysm case in an AIDS patient.
Methods
This 41-year-old AIDS patient presented with severe epistaxis. His head CT revealed acute blood in the left sphenoid sinus with bony erosion of the lateral wall (Fig. 1). The cerebral angiogram demonstrated a quite irregularly shaped intracavernous carotid artery aneurysm with proximal arterial stenosis (Fig. 2).
Results
After balloon test occlusion, this aneurysm was trapped endovascularly with detachable balloons (Fig. 3). The blood culture was positive for Aspergillus. The patient died 2 years later from other AIDS-related causes.
Conclusion
The cerebral aneurysms in HIV/AIDS patients can be generally categorized into two groups: the mycotic aneurysms from bacterial or fungal infections and the HIV-associated aneurysms as a distinct entity. To plan appropriate interventions, a high degree of clinical suspicion must be exercised to promptly recognize the mycotic nature of many HIV-related aneurysms.
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References
Epstein LG, Sharer LR, Oleske JM et al. Neurologic manifestations of human immunodeficiency virus infection in children. Pediatrics 1986;78:678–87.
Simpson DM, Tagliati M. Neurologic manifestations of HIV infection. Ann Intern Med 1994;121:769–85.
Bulsara KR, Raja A, Owen J. HIV and cerebral aneurysms. Neurosurg Rev 2005;28:92–5.
Connor MD, Lammie GA, Bell JE, Warlow CP, Simmonds P, Brettle RD. Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV Autopsy Cohort. Stroke 2000;31(9):2117–26.
Mizusawa H, Hirano A, Llena JF, Shintaku M. Cerebrovascular lesions in acquired immune deficiency syndrome (AIDS). Acta Neuropathol (Berl) 1988;76(5):451–7.
Gillams AR, Allen E, Hrieb K, Venna N, Craven D, Carter AP. Cerebral infarction in patients with AIDS. AJNR Am J Neuroradiol 1997;18(8):1581–5.
Husson RN, Saini R, Lewis LL, Butler KM, Patronas N, Pizzo PA. Cerebral artery aneurysms in children infected with human immunodeficiency virus. J Pediatr 1992;121:927–30.
Martinez-Longoria CA, Morales-Aguirre JJ, Villalobos-Acosta CP, Gomez-Barreto D, Cashat-Cruz M. Occurrence of intracerebral aneurysm in an HIV-infected child: a case report. Pediatr Neurol 2004;31:130–32.
Mazzoni P, Chiriboga CA, Millar WS, Rogers A. Intracerebral aneurysms in human immunodeficiency virus infection: case report and literature review. Pediatr Neurol 2000;23:252–55.
Patsalides AD, Wood LV, Atac GK, Sandifer E, Butman JA, Patronas NJ. Cerebrovascular disease in HIV-infected pediatric patients: neuroimaging findings. AJR Am J Roentgenol 2002;179(4):999–1003.
Cantu RC, LeMay M, Wilkinson HA. The importance of repeated angiography in the treatment of mycotic-embolic intracranial aneurysms. J Neurosurg 1966;25(2):189–9.
DuPont JR, Bonavita JA, DiGiovanni RJ, Spector HB, Nelson SC. Acquired immunodeficiency syndrome and mycotic abdominal aortic aneurysms: a new challenge? Report of a case. J Vasc Surg 1989;10:254–57.
Chetty R, Batitang S, Nair R. Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. Hum Pathol 2000;31:374–79.
Nair R, Robbs JV, Naidoo NG, Woolgar J. Clinical profile of HIV-related aneurysms. Eur J Vasc Endovasc Surg 2000; 20:235–40.
Dubrovsky T, Curless R, Scott G, Chaneles M, Post MJ, Altman N, Petito CK, Start D, Wood C. Cerebral aneurysmal arteriopathy in childhood AIDS. Neurology 1998;51(2):560–5.
Ren Z, Yao Q, Chen C. HIV-1 envelope glycoprotein 120 increases intercellular adhesion molecule-1 expression by human endothelial cells. Lab Invest 2002;82(3):245–55.
Kanmogne GD, Kennedy RC, Grammas P. HIV-1 gp120 proteins and gp160 peptides are toxic to brain endothelial cells and neurons: possible pathway for HIV entry into the brain and HIV-associated dementia. J Neuropathol Exp Neurol 2002;61(11):992–1000.
Saraya T, Shimura C, Wada H, Aoshima M, Goto H. Evidence for vascular spread of -varicella zoster-associated vasculopathy. Ann Intern Med 2006;144(7):535–7.
Kossorotoff M, Touze E, Godon-Hardy S, Serre I, Mateus C, Mas JL, Zuber M. Cerebral vasculopathy with aneurysm formation in HIV-infected young adults. Neurology. 2006;66(7):1121–2.
Chapot R, Houdart E, Saint-Maurice JP, Aymard A, Mounayer C, Lot G, Merland JJ. Endovascular treatment of cerebral mycotic aneurysms. Radiology 2002;222(2):389–96.
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Wang, H., Rammos, S., Fraser, K. et al. Successful Endovascular Treatment of A Ruptured Mycotic Intracavernous Carotid Artery Aneurysm in an AIDS Patient. Neurocrit Care 7, 156–159 (2007). https://doi.org/10.1007/s12028-007-0072-2
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DOI: https://doi.org/10.1007/s12028-007-0072-2