Clinical Neuroradiology

, Volume 28, Issue 3, pp 357–365 | Cite as

Considerations on the Relevance of Cerebral Fusiform Aneurysms Observed During HIV Infection

  • Bruno Law-ye
  • Robert-Yves Carlier
  • Raphaël Richard
  • Raphaël Blanc
  • Claire Jourdan
  • Pierre de Truchis
  • Flore Viry
  • Didier Dormont
  • Delphine Leclercq
  • Frédéric Clarençon
Original Article


Human immunodeficiency virus (HIV)-associated ectatic cerebral vasculitis (HIV-AECV) is a rare form of vasculitis with diffuse fusiform aneurysms. Its pathophysiology remains poorly understood. Although extensively described in children, it is still incompletely studied in adults. Our objective was to present five adult cases with emphasis on imaging findings and long-term evolution. From 2006 to 2014, we included 5 HIV-infected patients presenting with fusiform cerebral aneurysms. Vessels abnormalities were assessed with brain computed tomography (CT) angiography, magnetic resonance angiography (MRA) and/or digital subtraction angiography (DSA). All patients had MR assessment of the brain. Clinical and biological data were analyzed. Fusiform aneurysms of carotid terminations extending to middle and anterior cerebral arteries were bilateral in three patients and unilateral in one. More distal fusiform aneurysms were observed in four patients and saccular aneurysms in two patients, two patients suffered from ischemic lesions while none experienced hemorrhage. Unlike recent reviews, our study underlines the low hemorrhagic potential of HIV-AECV and long-term follow-up suggests a monophasic evolution under antiretroviral medication.


Human immunodeficiency virus Acquired immunodeficiency syndrome Cerebral vasculitis Fusiform aneurysm Circle of Willis 



Computed tomography


CT angiography


Digital subtraction angiography


Hepatitis C virus


Human immunodeficiency virus


HIV-associated ectatic cerebral vasculitis


Internal carotid artery


Magnetic resonance angiography


Magnetic resonance imaging



The authors would like to thank Dr David Zucman (Internal Medicine, Hôpital Foch, Suresnes, France) for his assistance in the preparation of this manuscript.

Compliance with ethical guidelines

Conflict of interests

B. Law-ye, R.-Y. Carlier, R. Richard, R. Blanc, C. Jourdan, P. de Truchis, F. Viry, D. Dormont, D. Leclercq and F. Clarençon declare that they have no competing interests.

Ethical standards

Neither approval of the institutional review board nor patient informed consent are required by the ethics committee of the institutions involved in this series for retrospective analysis of patients’ records and imaging data.


  1. 1.
    Ake JA, Erickson JC, Lowry KJ. Cerebral aneurysmal arteriopathy associated with HIV infection in an adult. Clin Infect Dis. 2006;43:e46–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Bonkowsky J, Pavia A. Cerebral vasculopathy with aneurysm formation in HIV-infected young adults. Neurology. 2007;68:623, author reply 623.CrossRefPubMedGoogle Scholar
  3. 3.
    Daugherty WP, Clarke MJ, Cloft HJ, Lanzino GL. Going viral: fusiform vertebrobasilar and internal carotid aneurysms with varicella angiitis and common variable immunodeficiency. J Neurosurg Pediatr. 2009;4:528–31.CrossRefPubMedGoogle Scholar
  4. 4.
    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;51:560–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Baeesa SS, Bakhaidar M, Almekhlafi MA, Madani TA. Human immunodeficiency virus-associated cerebral aneurysmal vasculopathy: a systematic review. World Neurosurg. 2016;87:220–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Modi G, Ranchod K, Modi M, Mochan A. Human immunodeficiency virus associated intracranial aneurysms: report of three adult patients with an overview of the literature. J Neurol Neurosurg Psychiatry. 2008;79:44–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Carvalho Neto Ad, Bruck I, Coelho LO, Cruz CR, Liu CB, Gomes AF, Ogata SA, Tahan TT. Cerebral arterial aneurysm in a child with acquired immunodeficiency syndrome: case report. Arq Neuropsiquiatr. 2001;59:444–8.CrossRefGoogle Scholar
  8. 8.
    Fischer E. Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir. 1938;3:300–13.Google Scholar
  9. 9.
    Edwards NJ, Grill MF, Choi HA, Ko NU. Frequency and risk factors for cerebral arterial disease in a HIV/AIDS Neuroimaging cohort. Cerebrovasc Dis. 2016;41:170–6.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Shah SS, Zimmerman RA, Rorke LB, Vezina LG. Cerebrovascular complications of HIV in children. AJNR Am J Neuroradiol. 1996;17:1913–7.PubMedGoogle Scholar
  11. 11.
    Tipping B, de Villiers L, Wainwright H, Candy S, Bryer A. Stroke in patients with human immunodeficiency virus infection. J Neurol Neurosurg Psychiatry. 2007;78:1320–4.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Tipping B, de Villiers L, Candy S, Wainwright H. Stroke caused by human immunodeficiency virus-associated intracranial large-vessel aneurysmal vasculopathy. Arch Neurol. 2006;63:1640–2.CrossRefPubMedGoogle Scholar
  13. 13.
    Fulmer BB, Dillard SC, Musulman EM, Palmer CA, Oakes J. Two cases of cerebral aneurysms in HIV+ children. Pediatr Neurosurg. 1998;28:31–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Lang C, Jacobi G, Kreuz W, Hacker H, Herrmann G, Keul HG, Thomas E. Rapid development of giant aneurysm at the base of the brain in an 8‑year-old boy with perinatal HIV infection. Acta Histochem Suppl. 1992;42:83–90.PubMedGoogle Scholar
  15. 15.
    Goldstein DA, Timpone J, Cupps TR. HIV-associated intracranial aneurysmal vasculopathy in adults. J Rheumatol. 2010;37:226–33.CrossRefPubMedGoogle Scholar
  16. 16.
    Sedat J, Alvarez H, Rodesch G, Lasjaunias P. Multifocal cerebral fusiform aneurysms in children with immune deficiencies report of four cases. Interv Neuroradiol. 1999;5:151–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hamilton DK, Kassell NF, Jensen ME, Dumont AS. Subarachnoid hemorrhage and diffuse vasculopathy in an adult infected with HIV. Case report. J Neurosurg. 2007;106:478–80.CrossRefPubMedGoogle Scholar
  18. 18.
    Echiverri HC, Rubino FA, Gupta SR, Gujrati M. Fusiform aneurysm of the vertebrobasilar arterial system. Stroke. 1989;20:1741–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Makita K, Tsuchiya K, Furui S, Yoshida H, Yamada H, Takiguchi H. Nondissecting vertebral fusiform aneurysm: embolization using wire-directed detachable balloons. AJNR Am J Neuroradiol. 1993;14:340–2.PubMedGoogle Scholar
  20. 20.
    Patil AKB, Azad ZR, Mathew V, Alexander M. Chronic meningitis and central nervous system vasculopathy related to Epstein Barr virus. Ann Indian Acad Neurol. 2012;15:303–6.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Piantino JA, Goldenberg FD, Pytel P, Wagner-Weiner L, Ansari SA. Progressive intracranial fusiform aneurysms and T‑cell immunodeficiency. Pediatr Neurol. 2013;48:130–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Delgado Almandoz JE, Crandall BM, Fease JL, Scholz JM, Anderson RE, Kadkhodayan Y, Tubman DE. Successful endovascular treatment of three fusiform cerebral aneurysms with the Pipeline Embolization Device in a patient with dilating HIV vasculopathy. J Neurointerv Surg. 2014;6:e12.CrossRefGoogle Scholar
  23. 23.
    Law-Ye B, Dormont D, Chiras J, Carlier R‑Y, Clarençon F. Successful endovascular treatment of three fusiform cerebral aneurysms with the Pipeline Embolization Device in a patient with dilating HIV vasculopathy. J Neurointerv Surg. 2015 Apr 3. doi: 10.1136/neurintsurg-2015-011730 [Epub ahead of print].CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Bruno Law-ye
    • 1
    • 2
  • Robert-Yves Carlier
    • 3
    • 4
    • 5
  • Raphaël Richard
    • 3
  • Raphaël Blanc
    • 6
  • Claire Jourdan
    • 7
  • Pierre de Truchis
    • 8
  • Flore Viry
    • 9
  • Didier Dormont
    • 1
    • 2
  • Delphine Leclercq
    • 1
  • Frédéric Clarençon
    • 1
    • 2
  1. 1.Neuroradiology DepartmentAPHP, Hôpital Pitié-SalpêtrièreParisFrance
  2. 2.Pierre et Marie Curie Faculty of MedicineSorbonne UniversitésParisFrance
  3. 3.Radiology DepartmentAPHP, Hôpital Raymond PoincaréGarchesFrance
  4. 4.Paris Ile-de-France Ouest Faculty of MedicineUniversité de VersaillesSaint-Quentin-en-YvelinesFrance
  5. 5.CIC 1429Raymond Hôpital Raymond PoincaréGarchesFrance
  6. 6.Neuroradiology DepartmentAPHP, Fondation Ophtalmologique Adolphe de RotschildParisFrance
  7. 7.Rehabilitation DepartmentAPHP, Hôpital Raymond PoincaréGarchesFrance
  8. 8.Infectious Diseases DepartmentAPHP, Hôpital Raymond PoincaréGarchesFrance
  9. 9.Radiology DepartmentAPHP, Hôpital Saint-AntoineParisFrance

Personalised recommendations