CEREBRAL INFARCTION IN 2 AIDS PATIENTS

Patients infected with the human immunodeficiency virus (HIV) appear t o have a high risk of ischaemic cerebral events. We observed two cases of cerebral infarction in patients with acquired immune deficiency sy ndrome (AIDS). In the first case, a 38-year-old homosexual with no car diovascular risk other than smoking presented with rapidly progressive hemiparesia. Brain CT-scan visualized two infarcts in the territory o f the right sylvian artery and the arteriography an occlusion of the i nternal carotid artery, In the second, a 37-year-old homosexual, hospi talization was required for a left-sided pure sensitive epilepsy seizu re. There was no cardiovascular risk other than smoking. Magnetic reso nance imaging showed parietal ischaemia and thrombus in the left atriu m without atrial hypertrophy was seen at transoesophageal echocardiogr aphy. In both cases, there was no evidence of endocarditis, dissection of the neck vessels or disseminated intravascular coagulation nor of associated viral or bacterial infectious complication of AIDS. Angiogr aphic findings eliminated cerebral vascularitis. Among the perturbed h aemostasis factors previously reported in HIV+ patients, we observed f ree proteins S deficiency (68 and 43%) and heparin cofactor II deficie ncy (54 and 40%), Serum albumin was 33 and 32 g/l respectively. Outcom e was favourable in both cases with anticoagulant therapy. These coagu lation anomalies would not appear sufficient to explain cerebral infar ction. Other mechanisms including immune complexed deposition, direct HIV toxicity for endothelial cells or the effect of cytokines on smoot h muscles fibres and fibroblasts are probably more important causal fa ctors.