Summary of all reported pediatric cases of HIV-related aneurysmal vasculopathy.
| Year /No. of cases | Age at aneurysm diagnosis (years)/gender/HIV source | Presentation | Radiological modality/Radiological findings/vessels involved | Management | Outcome | |
|---|---|---|---|---|---|---|
| Kure et al, 198914 | 6 yrs/male/congenital | Aphasia and quadriplegia | Fusiform dilatation of circle of Willis | NS | Death after 25 days in the hospital | |
| Lang et al, 199119 | 8 yrs/male/congenital | NS | Fusiform dilatations of left ICA, MCA, and ACA | AZT 5 years before CNS event | Died after one month secondary to cardiomyopathy | |
| Husson et al, 199213 | ||||||
| 1 | 11 yrs/male/blood transfusion | Asymptomatic | Multiple saccular aneurysms of right MCA and fusiform aneurysm of left ACA and MCA | DDI one year prior to the presentation changed to AZT after aneurysm diagnosis | CNS symptoms after 16 months | |
| 2 | 12 yrs/male/blood transfusion | Asymptomatic | multiple aneurysmal dilatations of the right MCA and ACA | DDI was continued after the diagnosis | Remained asymptomatic | |
| 3 | 12 yrs/female/congenital | Fever, lethargy, seizure and upper limbs weakness | Multiple fusiform ICA, ACA, MCA and right PCA aneurysms | NS | Death within 2 months of presentation | |
| Dubrovsky et al, 19982 | 1 | 13 yrs/male/uncertain | Acute right hemiparesis | Fusiform dilatations of left supraclinoid ICA and proximal ACA and MCA | AZT 18 months prior to the presentation, continued after diagnosis of the aneurysm | Death after 3 months secondary to cerebral infarction |
| 2 | 11 yrs/female/congenital | Acute change in mental status | Fusiform aneurysms of left ICA and proximal MCA and bilateral PCA | AZT started one year prior to the presentation | Death after 6 months secondary to infection | |
| 3 | 6 yrs/female/Congenital | Seizure | Multiple fusiform aneurysms of the right ICA and proximal right MCA | AZT since 2-year-old. Radiotherapy for brain lymphoma | Neurological status worsened gradually. Died later secondary to HIV-enteropathy | |
| 4 | 12 yrs/male/blood transfusion | Headache and left-sided weakness | Fusiform aneurysms of left ICA, MCA, and ACA | ART (DDI 2 years before the presentation | Multiple opportunistic infections after the presentation died after 36 months | |
| 5 | 10 yrs/male/perinatal | Collapsed at school | Not carried out | DDI started 2 years prior to the presentation | Death at presentation | |
| Fulmer et al, 19985 | 11 yrs/female/congenital | Asymptomatic | Multiple ICA, MCA, and ACA fusiform aneurysms | Observation | Death after 3 years was secondary to other AIDs complications | |
| Mazzoni et al, 200015 | 8 yrs/female/congenital | Sudden loss of consciousness followed by seizure and mild hemiparesis | multiple saccular and fusiform aneurysms in the proximal arteries, predominantly, in the left MCA | AZT was replaced with DDI at the age of 3 years. HAART (AZT, 3TC, RTV) was initiated after aneurysm diagnosis | Patient recovered after one month. After 4 months, repeated MRA showed no changes in the aneurysms | |
| Carvalho neto et al, 20016 | 6 yrs/male/congenital | Seizure | Aneurysmal dilatation of circle of Willis, more in the right. | AZT and DDI were started at the age of 2 years. Supportive management for the CNS event | The seizures stopped, and the patient was discharged with follow up in the clinic | |
| Nunes et al, 20013 | 2 months old/female/congenitally-acquired | Right hemiparesis and coma | Saccular aneurysm of left basilar artery. | IV AZT at birth. She was on AZT and DDI at presentation. Conservative management for SAH | Death after 12 days of SAH | |
| Patsalides et al, 200220 | 7 cases, (7yrs – 15 yrs), 5 males and 2 females, 4 perinatal and 3 through blood transfusion | NS | Aneurysms involved ICA, MCA, ACA, PCA, basilar and vertebral arteries | All were taking ART before the diagnosis of aneurysmal arteriopathy | 2 cases were alive through out the observation period; 4 cases died secondary to other AIDS-related complications and a single case died secondary to CNS complications | |
| Petropolous et al, 200317 | 12 yrs/male/NS | Asymptomatic | Multiple saccular aneurysms of proximal right ICA and proximal basilar artery | Continued the earlier started HAART (AZT, 3TC, NVP) with follow-up of the aneurysms | After 2 years follow-up, no new CNS symptoms, and MRI showed no changes | |
| Martinez-Longoria et al, 20041 | 12 yrs/female/congenital | Headache, transient left hemiparesis, blurred vision | Left ICA obstruction, stenosis in infraclinoid right ICA and fusiform dilatations of the right ICA bifurcation extends to right MCA and ACA | Initially on AZT. SQV and 3TC were started 3 month before CNS event. HAART regime (Kaletra® (LPV/RTV), 3TC and D4T) and aspirin was started after the CNS event | MRI after 15 months showed complete resolution of the aneurysm. No neurological event was occurred over 2 years follow-up | |
| Mahadevan et al, 200716 | 16 yrs/male/not known | Headache, vomiting, slurred speech and weakness | Fusiform dilatations of bilateral vertebral, basilar artery, right ICA, and MCA | A twist drill and ventricular tap did reduce the intracranial pressure | Death within hours of presentation | |
| Thakker and Bhatia 200910 | 12 yrs/male/congenital | Headache and right hemiparesis | Fusiform aneurysms of the left supraclinoid ICA | ART 4 months prior to the presentation. Conservative management of the aneurysm | No reported the death or other CNS manifestations | |
| Demopolous et al, 200918 | ||||||
| 1 | 12 yrs/male/NS | Right hemiparesis | Fusiform right ICA aneurysm | ART for 5 years prior to the presentation | Complete neurological recovery | |
| 2 | 6 yrs/female/NS | Left hemiparesis | Fusiform dilatations of right ICA, right vertebral, and basilar artery | ART for 6 months prior to the presentation | The residual weakness with neurocognitive impairment | |
| 3 | 7 yrs/Male/NS | Right hemiparesis | Multiple aneurysms of vessels of the circle of Willis | Did not receive ART | Death | |
| Savitr sastri et al, 20118 | 13 yrs/Male/NS | Aphasia and right hemiplegia | Fusiform dilatations of bilateral supraclinoid ICAs | External ventricular drain inserted | Death within hours of presentation | |
| Schieffelin et al, 20134 | ||||||
| 1 | 7 HIV-infected pediatric cases were reported to have cerebral aneurysm with no specific demographic | CNS symptoms | Aneurysmal dilatation of arteries in the circle of Willis | DDI at the time of CNS event | Alive | |
| 2 | blurred vision | Multiple aneurysms, multiple infarcts | HAART at the time of CNS event | Died | ||
| 3 | seizures, right hemiparesis | Internal carotid artery aneurysm | HAART at the time of CNS event | Died | ||
| 4 | CNS symptoms | Aneurysm of left ACA and narrowing of right MCA | HAART at the time of CNS event | Alive | ||
| 5 | Hemiplegia | Fusiform CNS aneurysm | HAART at the time of CNS event | Alive | ||
| 6 | CNS symptoms | Multiple CNS aneurysms | HAART at the time of CNS event | Alive | ||
| 7 | CNS symptoms | Diffuse CNS aneurysms with ectasia | D4T, NVP at the time of CNS event | Died | ||
| Current Case | 7 yrs/Male/Congenital | Headache and altered level of consciousness | fusiform aneurysm at left ICA bifurcation, and proximal ACA and MCA | Clipping of the aneurysm. Started on HAART before discharge | Discharged in a stable neurological condition to be followed up in the clinic | |