Recurrent Stroke as a Presenting Symptom of HIV-Associated Moyamoya Syndrome: Case Report (P05.242)

Abstract

Objective: To report a case of a recurrent stroke as a presenting symptom of a newly diagnosed HIV-associated MMS. Background There is increasing evidence that HIV infection is a risk factor of stroke. Moyamoya syndrome (MMS) is a progressive vasculopathy affecting the circle of Willis with collateral development. There are only four case reports of HIV associated MMS stroke. However, no recurrent strokes caused by newly diagnosed HIV associated MMS has been previously reported. Design/Methods: Case report. Results: A 35 year old African American male with past medical history of stroke and vertebral artery occlusion presented with acute onset of left facial droop, left hemiparesis and hemisensory loss, left sided neglect and right gaze preference. MRI showed a large right MCA territory infarct and MRA showed age indeterminant right vertebral artery occlusion at the origin, and right MCA occlusion. Subsequent cerebral angiogram revealed right MCA long segment stenosis with increased lenticulostriate proliferation consistent with early stages of MMS. On admission, his platelets count was 45, and thrombocytopenia evaluation revealed HIV (ELISA and WB positive,CD4+ count-137 and viral load -161,674). Further studies including CSF, echocardiogram, lipid panel, HgA1c, hypercoagulable and vasculitis workup were unremarkable. It is most likely that his previous stroke and vertebral artery stump occlusion was due to HIV vasculopathy. Conclusions: Recurrent stroke due to MMS could be the first presenting symptom of HIV. This case report underlines importance of Brain Attack Coalition recent revision recommending HIV testing for all stroke patients admitted to the Primary Stroke Centers. Disclosure: Dr. Alqadi has nothing to disclose. Dr. Nadareishvili has nothing to disclose. Dr. Jadhav has nothing to disclose. Dr. Burger has nothing to disclose. Dr. Khaldi has nothing to disclose. Dr. Feinberg has nothing to disclose.