Case report - AIDS complicated cerebral infraction and bleeding

 

Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a male aged 30 years, who had history of paid blood donation in the year of 1995. He was definitely diagnosed in Mar. 2004 and had recurrent herpes, eye sockets pain, itchy throat with prickling pain, decreased and blurred vision in Mar. 2004. Fundus examinations have findings of vascular bleeding of ocular fundus, degeneration and necrosis of retina. Fluorescent angiography of ocular fundus has findings of retina artery and vein occlusions. His CD4 count was 10 cells/μl.

 

Imaging demonstrations

Fig. 2-9-3 D

Fig. 2-9-3 A,B,C,D,E,F  Axial CT scanning demonstrating large flaky low density areas in right brain with small flaky high density areas, clearly-defined borders, deepened cortical sulci, decreased total cerebral volume and enlarged right cerebral ventricle.

 

Fig. 2-9-3K

Fig. 2-9-3 G,H,I,J,K,L,M,N,O  Axial MR imaging demonstrating large flaky high T1 signal in right brain, deepened and widened cortical sulci, enlarged lateral fissure cistern, enlarged right cerebral ventricle and decreased total cerebral volume.

Fig. 2-9-3R

Fig. 2-9-3 P,Q,R,S,T,U  Axial MR imaging demonstrating large flaky high T2 signal in right brain, small flaky high T2 signal in right basal ganglia region, deepened and widened cortical sulci, enlarged lateral fissure cistern, enlarged right cerebral ventricle and decreased total cerebral volume.

Fig. 2-9-3V

Fig. 2-9-3 V,W  MRA demonstrating occlusion of right cerebral middle-sized artery, distal stenosis of right large occipital artery, no blood flow signaling, vascular stenosis and sparseness of the left cerebral middle-sized artery and the left anterior cerebral artery with weakened blood flow signaling.

 

Diagnosis

AIDS complicated cerebral infraction and bleeding.

 

Discussion

This case is very special for his initial cytomegalovirus retinitis with symptoms of both eyes blindness in two weeks, followed by sever headache in the 3rd week, hemiplegia and pain of the left extremities and gatism. His brain CT scanning demonstrates large flaky infarction foci in right brain, whose differential diagnosis from non-AIDS cerebral infarction is difficult from the single perspective of medical imaging. However, the diagnosis is not difficult based on the combination with case history. Cerebrovascular disease among non-AIDS patients is one of the three major killers of human being. Data indicate cerebrovascular disease occupies 50% in nervous diseases of general hospitals in US. Classification of 756 cases cerebrovascular diseases suggests that 82% cases are cerebral infarction including 32% arteriosclerotic thrombosis, 18% lacouna infarction and 30% thrombolus, 11% cases primary cerebral bleeding and 7% cases secondary cerebral bleeding. In population with AIDS, 25.3% have nervous system complications, among which complications of cerebral infarction and bleeding after infarction occupies 23%, demonstrating high occurrence of cerebral infarction. CT scanning and MR imaging can clarify the diagnosis with their advantages of being quick, accurate and noninvasive.