Infectious Disease Department, Georgetown University Hospital, Washington, DC, USA.
J Rheumatol. 2010 Feb;37(2):226-33. doi: 10.3899/jrheum.090643. Epub 2009 Dec 15.
Diffuse fusiform intracranial aneurysms have been reported in children with human immunodeficiency virus (HIV) for over 2 decades, but have only recently been reported in adults with HIV. Although these aneurysms have important clinical implications, their etiology and optimal therapy are unknown. We present a systematic review of diffuse intracranial fusiform aneurysmal vasculopathy in patients who are HIV-positive. We conducted a comprehensive literature search for relevant case reports and reviews published before February 2009. Patients were included if they had HIV infection and radiographic imaging consistent with fusiform aneurysmal vasculopathy. We identify 11 published adult cases of intracranial fusiform aneurysmal vasculopathy and describe 1 unpublished case from our own institution. Available data regarding clinical presentation, characteristic imaging findings, and treatment of this complex syndrome are reviewed. Adults with HIV-associated intracranial aneurysmal vasculopathy typically are significantly immunosuppressed and present with gross neurologic dysfunction. Characteristic radiographic findings include diffuse cerebral fusiform aneurysms with hemorrhage or infarct. Treatment of any active infection followed by the initiation of antiretroviral therapy and corticosteroids may be a reasonable approach in this complex syndrome.
弥漫性梭形颅内动脉瘤在人类免疫缺陷病毒（HIV）感染的儿童中已有 20 多年的报道，但在 HIV 感染的成人中最近才被报道。尽管这些动脉瘤具有重要的临床意义，但它们的病因和最佳治疗方法尚不清楚。我们对 HIV 阳性患者的弥漫性颅内梭形动脉瘤性血管病进行了系统评价。我们对截至 2009 年 2 月之前发表的相关病例报告和综述进行了全面的文献检索。如果患者有 HIV 感染和与梭形动脉瘤性血管病一致的影像学表现，则将其纳入研究。我们共发现 11 例已发表的成人颅内梭形动脉瘤性血管病病例，并描述了 1 例来自我们自己机构的未发表病例。对该复杂综合征的临床表现、特征性影像学发现和治疗的相关数据进行了综述。HIV 相关颅内动脉瘤性血管病的成人患者通常存在严重的免疫抑制，并表现为严重的神经功能障碍。特征性的影像学表现包括弥漫性脑梭形动脉瘤伴出血或梗死。任何活动性感染的治疗后，接着进行抗逆转录病毒治疗和皮质类固醇治疗可能是该复杂综合征的合理方法。
