Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
J Neuroradiol. 2013 Jul;40(3):172-80. doi: 10.1016/j.neurad.2012.08.001. Epub 2013 Jun 2.
Although HIV infection is decreasing in infants and children, there is a steady cohort of perinatally HIV-infected (PHIV) children that are growing older. Increased risk of acute stroke has been reported in PHIV children. Our goal was to evaluate evolution/progression of neuroimaging findings in PHIV youth initially presenting with acute stroke.
The medical records of PHIV pediatric patients (n = 179) from 1996 to 2010 were reviewed and patients with clinical documentation of acute stroke referred to the neuroradiology service were eligible for the study. Neuroimaging (brain CT, MRI, and MRA) and charts were evaluated; clinical and neuroimaging findings at the initial acute stroke and at the last presentation to the neuroradiology service were documented and analyzed.
Eight PHIV patients with clinical findings of acute stroke referred to the neuroimaging were identified. CT and MRI findings of infarction were found in all (8/8) patients in their first and/or last neuroimaging study; including basal ganglia-thalami (BGT) infarction (7/8), focal cortical infarction (4/8), and internal capsule infarction (4/8). Imaging depicted cortical atrophy (5/8), BGT calcification (3/8), and posterior reversible encephalopathy syndrome, wallerian degeneration, and periventricular white matter hyperintense T2 signal each in one patient. No tumors or infectious masses, cysts or abscesses were identified. Subsequent available neuroimaging revealed progression of the cerebrovascular disease in seven patients, 5/7 in the absence of new clinical signs or symptoms. Segmental occlusion, narrowing or narrowing/dilatation in the circle of Willis was found in 6/6 patients who underwent MR angiography and fusiform aneurysms were detected in three of them, a saccular aneurysm in one patient.
Asymptomatic progression of cerebrovascular disease was found in PHIV adolescents with prior stroke. These findings may have implications for long-term risk and outcomes for this patient population. There should be a low threshold to evaluate for CNS pathology even with minor symptoms in this population. More studies are necessary to determine if there is a benefit from screening of asymptomatic patients.
尽管 HIV 感染在婴幼儿中呈下降趋势，但仍有稳定的一组围产期 HIV 感染（PHIV）儿童在逐渐长大。已有报道称 PHIV 儿童患急性中风的风险增加。我们的目标是评估最初表现为急性中风的 PHIV 青少年的神经影像学表现的演变/进展。
回顾了 1996 年至 2010 年期间 PHIV 儿科患者（n=179）的病历，有临床记录的急性中风患者转诊至神经放射科的符合研究条件。评估了神经影像学（脑 CT、MRI 和 MRA）和图表；记录并分析了最初急性中风时和最后一次就诊神经放射科时的临床和神经影像学发现。
确定了 8 例有急性中风临床发现的 PHIV 患者转诊至神经影像学检查。在所有 8 例患者的首次和/或最后一次神经影像学研究中均发现了梗死的 CT 和 MRI 表现；包括基底节-丘脑（BGT）梗死（7/8）、局灶性皮质梗死（4/8）和内囊梗死（4/8）。影像学显示皮质萎缩（5/8）、BGT 钙化（3/8）和后部可逆性脑病综合征、瓦勒变性和脑室周围白质高信号 T2 信号各在 1 例患者中发现。未发现肿瘤或感染性肿块、囊肿或脓肿。随后的可用神经影像学显示 7 例患者的脑血管疾病进展，5/7 例在无新的临床体征或症状的情况下进展。6 例接受磁共振血管造影的患者发现 Willis 环节段闭塞、狭窄或狭窄/扩张，其中 3 例发现梭形动脉瘤，1 例发现囊状动脉瘤。
先前患有中风的 PHIV 青少年发现无症状性脑血管疾病进展。这些发现可能对该患者群体的长期风险和结局有影响。即使在该人群中出现轻微症状，也应降低评估中枢神经系统病变的阈值。需要更多的研究来确定对无症状患者进行筛查是否有益。
