Intracranial Arterial Dissection Related to HIV Infection. A Case Report with Histology

Abstract

There are many reasons for patients infected with human immunodeficiency virus (HIV) to develop cerebrovascular disease. The HIV virus itself however may be a cause of vessel wall pathology. We present a clinical and pathological study of a patient who was HIV positive and presented with a subarachnoid haemorrhage. Cerebral angiography and later histology confirm that there was extensive vessel wall injury with dissection and a false aneurysm of the right middle cerebral artery.

Figure 1

Lateral and oblique angiogram images of the right carotid showing the false aneurysm as well as an irregular M2 branches with areas of dilatation and narrowing.

Figure 2

The final angiogram after placing three undersized soft coils into the false lumen. At this point there was already delayed flow in the distal middle cerebral vessels.

Figure 3

Haematoxylin and eosin stain (H & E). Section through the basilar artery showing areas of intimal thickening, disruption of the internal elastic lamina and new vessels in the adventitia.

Figure 4

Elastic von Giesson stain (EVG). A high power view of a dissected area of the middle cerebral artery with blood tracking into the media layer of the vessel. Numerous new vessels can also be seen within the adventitia layer.

Figure 5

EVG stain and H & E stain. A low power and high power view of the distal middle cerebral artery showing organizing thrombus within the lumen, an irregularly thickened intima and disruption of the internal elastic lamina. Poor cohesion between internal elastic lamina and adventitia creates artefactual splits.