Giant serpentine aneurysm of vertebrobasilar artery mimicking dolichoectasia--an unusual complication of pediatric AIDS. Report of a case with review of the literature.
Giant serpentine aneurysm of vertebrobasilar artery mimicking dolichoectasia--an unusual complication of pediatric AIDS. Report of a case with review of the literature.
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DOI：
10.5414/npp27037
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发表时间：
2008
影响因子：
1.1
通讯作者：
Anita Mahadevan;R. Tagore;N. Siddappa;V. Santosh;T. Yasha;U. Ranga;B. Chandramouli;S. Shankar
中科院分区：
文献类型：
--
作者：
Anita Mahadevan;R. Tagore;N. Siddappa;V. Santosh;T. Yasha;U. Ranga;B. Chandramouli;S. Shankar
儿童获得性免疫缺陷综合症（艾滋病）的中枢神经系统表现与成人显着不同。发育迟缓、亚急性艾滋病脑炎和基底神经节钙化在儿童中很常见，而成人的机会性感染和痴呆则相反。颅内动脉瘤在儿科艾滋病中的发病率越来越高。威利斯环血管梭状扩张形成大动脉瘤，称为脑动脉瘤性儿童动脉病，是一种极其罕见的儿童艾滋病并发症。我们报告了一例类似先天性多长扩张症的椎基底系统大规模梭状扩张的病例，有证据表明 HIV-1 C 分支病毒直接导致。鉴于关于儿科艾滋病这种不寻常并发症的文献很少，我们对所有以前记录的病例进行了详细回顾，并回顾了发病机制。迄今为止，有 20 份报告（32 例）记录在案，大部分涉及前循环，发生在 4-15 岁之间。其发生与严重的免疫抑制有关，围产期感染艾滋病毒与症状出现的潜伏期为 5.5-11 年。 HIV 直接因果关系受到青睐，因为有报告表明受影响的血管中存在病毒，与高病毒载量相关，更确切地说，通过早期开始高效抗逆转录病毒治疗 (HAART) 可以阻止进展或逆转。这些动脉瘤的梭形性质和位置使得任何形式的手术干预或栓塞都是不可能的。因此，对此实体的高度临床怀疑和认识非常重要，因为这可能使年轻患者面临重大脑血管事故的风险。
Central nervous system manifestations of acquired immunodeficiency syndrome (AIDS) in children differ strikingly from adults. Developmental delay, subacute AIDS encephalitis and basal ganglia calcification are common in children, in contrast to opportunistic infections and dementia in adults. Intracranial aneurysms are being recognized with increasing frequency in pediatric AIDS. Fusiform dilatation of vessels of circle of Willis to form large aneurysms, termed cerebral aneurysmal childhood arteriopathy, is an exceedingly rare complication of pediatric AIDS. We report a case of massive fusiform dilatation of vertebrobasilar system mimicking congenital dolichoectasia with evidence suggesting direct causation by HIV-1 Clade C virus. In view of scant literature that exists on this unusual complication of pediatric AIDS, we present a detailed review of all previously recorded cases and review the etiopathogenesis. There are 20 reports (32 cases) on record till date that have mostly involved the anterior circulation, occurring between 4-15 years of age. Occurrence is associated with profound immunosuppression, and perinatally acquired HIV with latent interval of 5.5-11 years to onset of symptoms. Direct causation by HIV is favored as reports demonstrate presence of virus in affected vessels, association with high viral load and, more conclusively, arrest in progression or reversal with early initiation of highly active antiretroviral therapy (HAART). The fusiform nature and location of these aneurysms makes any form of surgical intervention or embolization impossible. High degree of clinical suspicion and awareness of this entity is, therefore, important as this can place young patients at risk for major cerebrovascular accidents.