AIDS and Intracranial Venous Thrombosis
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| Head Magnetic Resonance Imaging (Panel A)+. enlarge image |
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Venogram (Panel B). enlarge image |
A 43 year old woman with no past medical history presented with 3 weeks of difficulty breathing and reduced exercise tolerance associated with a dry cough, weakness and weight loss. She was diagnosed with PCP and tested positive for HIV. One week later she developed right sided headache associated with right retro-orbital pain, bilateral visual blurring, nausea and vomiting. Results of the lumbar puncture were unremarkable.
Magnetic resonance imaging and venogram of the head revealed
extensive thromboses in the superior sagittal and transverse sinuses
focal lesion in right caudate,with peripheral enhancement
focal lesion in the left thalamus without peripheral enhancement
Hypercoagulable states have been reported in patients with AIDS, including the presence of antiphospholipid antibodies, decreased levels of protein C and protein S, or an increased level of von Willebrand factor. This patient was treated with a course of coumadin and started on antiretroviral therapy with good clinical response.
Reading:
Afsari K, Frank J, Vaksman Y, Nguyen TV. Intracranial venous sinus thrombosis complicating AIDS-associated nephropathy. AIDS Read. 2003 Mar;13(3):143-8.
Iranzo A, Domingo P, Cadfalch J, Sambeat MA. Intracranial venous and dural sinus thrombosis due to protein S deficiency in a patient with AIDS. J Neurol Neurosurg Psychiatry. 1998 May;64(5):688.
Aboulafia DM, Mitsuyasu RT. Hematologic abnormalities in AIDS. Hematol Oncol Clin North Am 1991;5:195–209.
Abuaf N, Laperche S, Rajoely B, et al. Autoantibodies to phospholipids and to the coagulation proteins in AIDS. Thromb Haemost 1997;77:856–861.
Tsering Yangzom, MD Fellow
Randa Hamadeh, MD, Attending
Bellevue Hospital and Tisch Hospital
New York, NY, 10016
