HIV-associated intracranial aneurysmal vasculopathy was initially described primarily in pediatric patients but can be seen in adults as well. The vasculopathy may be the presenting feature of underlying HIV disease.
Patients have HIV disease with high viral load (> 100,000 copies/mL) and low CD4 counts (< 200 per µL).
Clinical findings:
(1) confusion and cognitive deficits
(2) dysarthria
(3) hemiparesis
Imaging studies show a fusiform intracranial vascular disorder with dilatation and aneurysms. Lesions may be multiple and bilateral.
The lesions may be associated with:
(1) ischemic and hemorrhagic strokes
(2) intracranial hemorrhage
The diagnosis requires that the changes cannot be better explained by infection with cytomegalovirus, Herpes zoster, syphilis, Mycobacteria or bacterial pathogens.
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