Abstract Details

Title Moyamoya Syndrome in a Patient with Congenital HIV Infection

Topic Infections/AIDS/Prion Disease

Presentation(s) P03 - (-)

Poster/Presentation
Number 255

Objective

Background BACKGROUND: Moyamoya describes a rare cerebrovascular phenomenon that may cause strokes due to stenosis of the intracranial carotid arteries and its proximal branches. The effect of HIV and AIDS on cerebral vasculature is unclear and may play causative a role in strokes.

Design/Methods DESIGN/METHODS: Retrospective chart review and PubMED online literature search was performed.

Results RESULTS: A 26 year-old female with a past medical history of congenital HIV treated with an antiretroviral regimen, 2 previous left-sided strokes, hypertension, and focal right-sided clonic seizures presented with right hand and wrist weakness. Magnetic resonance imaging was obtained showing an acute left parietal lobe infarct and stenotic left middle cerebral artery (MCA). She subsequently underwent angioplasty and then stenting of this vessel, which failed to maintain patency. On her third admission, the patient underwent cerebral angiogram which showed bilateral intracerebral carotid stenosis and collateralization indicative of moyamoya syndrome. Hepatitis, CMV, and TB panels were negative, and proteins C & S, ESR, and CRP were within normal limits. HIV viral load was 156 copies per milliliter, and CD4+ count was 700 cells per microliter. A left external carotid-internal carotid bypass graft was performed on this admission. In 2012, the patient returned for an elective follow-up angiogram that showed that the EC-IC graft was still patent.

Conclusions CONCLUSIONS: Current literature describes one child with congenital HIV infection, two adults with AIDS, and one adult with HIV infection all exhibiting moyamoya phenomenon on angiography. Pathologic mechanisms hypothesized to describe this include cytokine dysregulation, progression of pre-existing CNS vasculitis, endothelial cell infection, and unknown adverse effects of retroviral agents. CNS pathology associated with HIV infection is a rare and unexplored phenomenon and warrants further investigation into this virus's effect on the brain's vasculature.

Authors/Disclosures
Imad R. Khan, MD (University of Rochester Medical Center) PRESENTER	The institution of Dr. Khan has received research support from National Institute of Neurological Diseases and Stroke. The institution of Dr. Khan has received research support from National Heart Lung and Blood Institute. The institution of Dr. Khan has received research support from National Institute of Neurological Diseases and Stroke.
	No disclosure on file
Fawaz Al-Mufti, MD (Westchester Medical Center at New York Medical College)	Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Revalesio .
Candice Perkins, MD (Candice Perkins Md)	Dr. Perkins has nothing to disclose.

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