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Objectives: There is growing evidence of cerebral vasculopathy associated with HIV infection. We describe a case of spontaneous artery dissection in an HIV-infected patient as a new manifestation of HIV-vasculopathy.
Methods: We evaluated our patient using a native CT scan, intra- and extracranial MRI angiography, extra- and transcranial Doppler. We performed extensive laboratory tests and CSF-analysis including an autoantibody screening, serologies for syphilis, VZV, HSV, EBV, CMV, B and C hepatitis viruses, Borrelia burgdorferi as well as a CSF gram stain and CSF-cytology.
Results: We admitted a 39-year-old man with a 7 day history of right-frontal headache, hypesthesia in the N. trigeminus I territory and a right-sided Horner-Syndrome. He had HIV diagnosed in 07/2007 and an incompliance for antiretroviral medication intake. Extensive blood and CSF-analysis showed regular results, HIV-RNA load of 3,7 log10/ml, CD4/CD8 ratio of 0.62 with a total CD4 lymphocyte count of 0.49 G/l. The MRI-angiography as well as the Doppler-studies showed a long-segment dissection of the right A. carotis interna ca. 1cm distal of the carotid-bifurcation, without any evidence for fresh cerebral infarctions. The patient showed a history of arterial hypertension and hypercholesterolemia. There was no other evidence for risk factors including trauma, chiropractic manipulation, cerebral vasculitis or connective-tissue-disorders.
Conclusion: While pathophysiology remains unclear, HIV is known to cause cerebral vasculopathy which leads primarily to the formation of cerebral aneurysms. We propose dissection as a new manifestation of HIV-vasculopathy, although a causal link between an HIV-infection of our patient and the carotid artery dissection cannot be definitely established. This association may play an important role clinical practice since arterial dissection can lead to stroke in otherwise young and fit patients with an HIV-infection.