Stroke in HIV patients
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Revision as of 14:33, 13 July 2024 by Aidan (talk | contribs) (Created page with "== Background == === Etiologies === * Routine causes ** Large artery atherosclerotic disease (11 to 42%) ** Small-vessel disease (2 to 35%) ** Cardioembolic (3 to 19%) * Infectious (3 to 25%), including (from most to least common): VZV, infective endocarditis, tuberculosis, syphilis, meningitis not otherwise specified, cryptococcosis, toxoplasmosis, bacterial meningitis, mucormycosis, other Opportunistic infections in HIV|opportuni...")
Background
Etiologies
- Routine causes
- Large artery atherosclerotic disease (11 to 42%)
- Small-vessel disease (2 to 35%)
- Cardioembolic (3 to 19%)
- Infectious (3 to 25%), including (from most to least common): VZV, infective endocarditis, tuberculosis, syphilis, meningitis not otherwise specified, cryptococcosis, toxoplasmosis, bacterial meningitis, mucormycosis, other opportunistic infection
- Other causes (2 to 27%), including (from most to least common): vasculitis, cocaine use, non-atherosclerotic vasculopathy, multiple etiologies, arterial dissection, medication use, sickle cell crisis, carcinomatous meningitis, carotid stump syndrome
- Cryptogenic (10 to 32%)
Investigations
- Assess for rash, manifestations of neurosyphilis, signs of infection
- Laboratory investigations
- If indicated, lumbar puncture for cell count, protein, glucose, and other infectious workup
- CBC, CD4, HIV viral load, ESR/CRP, ANA, ANCA, antiphospholipid antibodies, syphilis serology
- Blood cultures
- Toxoplasma IgG if not previously documented
- As indicated, other infectious serologies
- Imaging and other procedures
- Brain imaging including vasculature
- Chest x-ray
- Echocardiography
- ECG
- Cardiac rhythm monitoring
Further Reading
- Stroke in HIV. Can J Cardiol. 2019 Mar;35(3):280-287. doi: 10.1016/j.cjca.2018.11.032. PMID: 30825950; PMCID: PMC6400325.
