Patient Case -  AIDS Complicated Cerebral Infarction and Bleeding

 

Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a male aged 41 years, who had history of paid blood donation. He was definitely diagnosed in Feb. 2003 and had symptoms of headache, dizziness, nausea and asthenia of right extremities in Dec. 2002. His CD4 count was 23 cells/μl.

 

Imaging demonstrations

Fig. 2-9-1 A                              Fig. 2-9-1 E

Fig. 2-9-1 F

Fig. 2-9-1 A  CT scanning demonstrating enlarged left temporal lobe, lateral fissure cistern and lateral cerebral ventricle with predominant enlargement of cornu posterius ventriculi lateralis.

Fig. 2-9-1 B,C,D,E  MR imaging demonstrating strip-liked high T1 signal in left thalamus, enlarged left temporal lobe, lateral fissure cistern and lateral cerebral ventricle with predominant enlargement of cornu posterius ventriculi lateralis.

Fig. 2-9-1 F  MRA demonstrating weakened blood flow signaling.

 

Diagnosis

AIDS complicated cerebral infarction.

 

Discussion

Patients with HIV infection have hyperplasia and granuloma of the inner wall of the blood vessels due to its nature of vessel-philia, leading to vascular stenosis or bleeding. For this case, the patient is young with CT scanning and MR imaging demonstrations of left temporal lobe atrophy, enlarged cerebral ventricles and later fissure cistern and with MRA findings of distal vascular stenosis of left cerebral middle-sized artery, arising from distal vascular inner membrane thickening and granuloma of left cerebral middle-sized artery due to HIV infection and the following blood supplying disturbance. Causes of limited cerebral atrophy among non-AIDS patients are degenerative diseases, such as cerebral trauma, infection, cerebrovascular diseases, cerebral dysplasia and Pick’s disease, etc. that usually is found in senior citizens. The causes of limited cerebral atrophy are different, but its CT scanning and MR imaging demonstrations are almost the same. CT scanning and MR imaging demonstrate signs of cerebral atrophy and abnormal signs of different primary diseases. The diagnosis can be made based on the combination with case history.