Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
J Neurovirol. 2020 Aug;26(4):474-481. doi: 10.1007/s13365-020-00867-8. Epub 2020 Jul 6.
HIV is known to increase the risk of both ischemic and hemorrhagic strokes. There are many postulated mechanisms for this elevated risk including an HIV-induced vasculopathy and/or coagulopathy, opportunistic infections, and cardioembolic etiologies, among others. Regarding vasculopathy, prior reports have described the various changes to the arterial vasculature that can occur in the setting of HIV, yet the appropriate workup and management of this condition remains poorly defined. Here we describe two cases of patients with HIV presenting with large vessel intracranial occlusions in the setting of ectatic extracranial vasculature accompanied by intraluminal thrombus formation. One patient underwent thrombectomy, while the other improved after receiving IV-tPA. Inferring on these cases and the existing literature, a standardized workup and treatment algorithm is proposed, emphasizing the key management decisions that should be considered on a case-by-case basis.
HIV 已知会增加缺血性和出血性中风的风险。这种风险升高的原因有很多，包括 HIV 引起的血管病变和/或凝血功能障碍、机会性感染以及心源性栓塞等。关于血管病变，先前的报告描述了 HIV 患者中可能发生的各种动脉血管变化，但这种情况的适当检查和治疗仍未明确定义。在这里，我们描述了两例 HIV 患者的病例，他们在扩张的颅外血管中出现大血管颅内闭塞，伴有管腔内血栓形成。一名患者接受了血栓切除术，另一名患者在接受 IV-tPA 后病情有所改善。根据这些病例和现有文献，提出了一种标准化的检查和治疗算法，强调了应根据具体情况考虑的关键管理决策。
