Considerations on the Relevance of Cerebral Fusiform Aneurysms Observed During HIV Infection
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.
KeywordsHuman immunodeficiency virus Acquired immunodeficiency syndrome Cerebral vasculitis Fusiform aneurysm Circle of Willis
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.
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.
- 8.Fischer E. Die Lageabweichungen der vorderen Hirnarterie im Gefässbild. Zentralbl Neurochir. 1938;3:300–13.Google Scholar
- 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.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