Extracranial ectasia and embolic infarcts in HIV: two case reports and a clinical decision-making algorithm.
Rakhee LallaPrashant RaghavanJohn W ColePublished in: Journal of neurovirology (2020)
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.
Keyphrases
- antiretroviral therapy
- hiv positive
- hiv infected
- hiv testing
- human immunodeficiency virus
- hepatitis c virus
- hiv aids
- men who have sex with men
- case report
- machine learning
- south africa
- emergency department
- systematic review
- deep learning
- internal carotid artery
- oxidative stress
- endothelial cells
- ischemia reperfusion injury
- high glucose
- optic nerve
- electronic health record