MRI in human immunodeficiency virus-associated cerebral vasculitis

Cerebral ischaemia caused by inflammatory vasculopathies has been described as complication of human immunodeficiency virus (HIV) infection. Imaging s tudies have shown ischaemic lesions and changes of the vascular lumen, but did not allow demonstration of abnormalities within the vessel wall itself. Two HIV-infected men presented with symptoms of a transient ischaemic atta ck. Initial MRI of the first showed no infarct; in the second two small lac unar lesions were detected. In both cases, multiplanar 3-mm slice contrast- enhanced T1-weighted images showed aneurysmal dilatation, with thickening a nd contrast enhancement of the wall of the internal carotid and middle cere bral (MCA) arteries. These findings were interpreted as indicating cerebral vasculitis. In the first patient the vasculopathy progressed to carotid ar tery occlusion, and he developed an infarct in the MCA territory, but then remained neurologically stable. In the second patient varicella tester viru s (VZV) infection was the probable cause of vasculitis. The clinical defici ts and vasculitic MRL changes regressed with antiviral and immunosuppressiv e therapy.