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Published in: BMC Infectious Diseases 1/2018

Open Access 01-12-2018 | Case report

Multimodal computed tomography-guided intravenous rtPA for aborted stroke in a HIV-infected young man: a case report

Authors: Ping Liu, Min Wu, Ning Zhang, Chunyou Chen, Bing Xiong, Xiaoying Zhang

Published in: BMC Infectious Diseases | Issue 1/2018

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Abstract

Background

Human immunodeficiency virus (HIV) infection has been recognized as a risk factor for both ischemic and hemorrhagic stroke among young adults. However, information on the optimal management of HIV patients presenting with presumed acute ischemic stroke within the time window of intravenous recombinant tissue plasminogen activator (IV-rtPA) thrombolysis is limited. To the best of our knowledge, the use of multimodal computed tomography (CT)-based imaging to guide acute-phase treatment for patients with HIV infection has never been reported.

Case presentation

We report the clinical, imaging, and immunological features of a young man suffering from presumed acute ischemic stroke, initially without awareness of the presence of HIV infection. IV-rtPA guided by multimodal CT, including brain CT angiography (CTA) and CT perfusion (CTP), was administered at the emergency department. His symptoms were relieved, and there was no recurrence during the 2-month follow up.

Conclusions

Mutimodal CT is a valuable and promising tool for the early management of HIV-infected patients, especially for those presenting within the strict thrombolysis time window.
Literature
1.
go back to reference Singhal AB, Biller J, Elkind MS, Fullerton HJ, Jauch EC, Kittner SJ, Levine DA, Levine SR. Recognition and management of stroke in young adults and adolescents. Neurology. 2013;81(12):1089–97.CrossRefPubMedPubMedCentral Singhal AB, Biller J, Elkind MS, Fullerton HJ, Jauch EC, Kittner SJ, Levine DA, Levine SR. Recognition and management of stroke in young adults and adolescents. Neurology. 2013;81(12):1089–97.CrossRefPubMedPubMedCentral
2.
go back to reference AbdelRazek MA, Gutierrez J, Mampre D, Cervantes-Arslanian A, Ormseth C, Haussen D, Thakur KT, Lyons JL, Smith BR, O'Connor O, et al. Intravenous thrombolysis for stroke and presumed stroke in human immunodeficiency virus-infected adults: a retrospective. Multicenter US Study Stroke. 2018;49(1):228–31.CrossRefPubMed AbdelRazek MA, Gutierrez J, Mampre D, Cervantes-Arslanian A, Ormseth C, Haussen D, Thakur KT, Lyons JL, Smith BR, O'Connor O, et al. Intravenous thrombolysis for stroke and presumed stroke in human immunodeficiency virus-infected adults: a retrospective. Multicenter US Study Stroke. 2018;49(1):228–31.CrossRefPubMed
3.
go back to reference Gutierrez J, Albuquerque A, Falzon L. HIV infection as vascular risk: a systematic review of the literature and meta-analysis. PLoS One. 2017;12(5):e176686.CrossRef Gutierrez J, Albuquerque A, Falzon L. HIV infection as vascular risk: a systematic review of the literature and meta-analysis. PLoS One. 2017;12(5):e176686.CrossRef
4.
go back to reference Tomandl BF, Klotz E, Handschu R, Stemper B, Reinhardt F, Huk WJ, Eberhardt KE, Fateh-Moghadam S. Comprehensive imaging of ischemic stroke with multisection CT. Radiographics. 2003;23(3):565–92.CrossRefPubMed Tomandl BF, Klotz E, Handschu R, Stemper B, Reinhardt F, Huk WJ, Eberhardt KE, Fateh-Moghadam S. Comprehensive imaging of ischemic stroke with multisection CT. Radiographics. 2003;23(3):565–92.CrossRefPubMed
5.
go back to reference Espinosa DRM, Parrilla G, Manzano-Fernandez S, Garcia-Villalba B, Zamarro J, Hernandez-Fernandez F, Sanchez-Vizcaino C, Carreon E, Morales A, Moreno A. Combined multimodal computed tomography score correlates with futile recanalization after Thrombectomy in patients with acute stroke. Stroke. 2015;46(9):2517–22.CrossRef Espinosa DRM, Parrilla G, Manzano-Fernandez S, Garcia-Villalba B, Zamarro J, Hernandez-Fernandez F, Sanchez-Vizcaino C, Carreon E, Morales A, Moreno A. Combined multimodal computed tomography score correlates with futile recanalization after Thrombectomy in patients with acute stroke. Stroke. 2015;46(9):2517–22.CrossRef
6.
go back to reference Barlinn K, Seibt J, Engellandt K, Gerber J, Puetz V, Kepplinger J, Wunderlich O, Pallesen LP, Bodechtel U, Koch R, et al. Multimodal computed tomography based definition of cerebral imaging profiles for acute stroke reperfusion therapy (CT-DEFINE): results of a prospective observational study. Clin Neuroradiol. 2015;25(4):403–10.CrossRefPubMed Barlinn K, Seibt J, Engellandt K, Gerber J, Puetz V, Kepplinger J, Wunderlich O, Pallesen LP, Bodechtel U, Koch R, et al. Multimodal computed tomography based definition of cerebral imaging profiles for acute stroke reperfusion therapy (CT-DEFINE): results of a prospective observational study. Clin Neuroradiol. 2015;25(4):403–10.CrossRefPubMed
7.
go back to reference Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, Pineda C, Serena J, van der Schaaf I, Waaijer A, et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006;37(4):979–85.CrossRefPubMed Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, Pineda C, Serena J, van der Schaaf I, Waaijer A, et al. Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 2006;37(4):979–85.CrossRefPubMed
8.
go back to reference Uchino K, Massaro L, Hammer MD. Transient ischemic attack after tissue plasminogen activator: aborted stroke or unnecessary stroke therapy? Cerebrovasc Dis. 2010;29(1):57–61.CrossRefPubMed Uchino K, Massaro L, Hammer MD. Transient ischemic attack after tissue plasminogen activator: aborted stroke or unnecessary stroke therapy? Cerebrovasc Dis. 2010;29(1):57–61.CrossRefPubMed
10.
go back to reference Benjamin LA, Bryer A, Emsley HC, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol. 2012;11(10):878–90.CrossRefPubMedPubMedCentral Benjamin LA, Bryer A, Emsley HC, Khoo S, Solomon T, Connor MD. HIV infection and stroke: current perspectives and future directions. Lancet Neurol. 2012;11(10):878–90.CrossRefPubMedPubMedCentral
11.
go back to reference Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med. 1990;112(9):682–98.CrossRefPubMed Love PE, Santoro SA. Antiphospholipid antibodies: anticardiolipin and the lupus anticoagulant in systemic lupus erythematosus (SLE) and in non-SLE disorders. Prevalence and clinical significance. Ann Intern Med. 1990;112(9):682–98.CrossRefPubMed
12.
go back to reference Santos JL, Cruz I, Martin HF, Albarran C, Gonzalez MJ, Martin LC. Recurrent coronary thrombosis, factor V Leiden, primary antiphospholipid syndrome and HIV. Rev Esp Cardiol. 2004;57(10):997–9.CrossRefPubMed Santos JL, Cruz I, Martin HF, Albarran C, Gonzalez MJ, Martin LC. Recurrent coronary thrombosis, factor V Leiden, primary antiphospholipid syndrome and HIV. Rev Esp Cardiol. 2004;57(10):997–9.CrossRefPubMed
13.
go back to reference Gorczyca I, Stanek M, Podlasin B, Furmanek M, Pniewski J. Recurrent cerebral infarcts as the first manifestation of infection with the HIV virus. Folla Neuropathol. 2005;43(1):45–9. Gorczyca I, Stanek M, Podlasin B, Furmanek M, Pniewski J. Recurrent cerebral infarcts as the first manifestation of infection with the HIV virus. Folla Neuropathol. 2005;43(1):45–9.
14.
go back to reference Lee SS, Cho ML, Joo YS, Kim WU, Hong YS, Min JK, Lee SH, Park SH, Cho CS, Kim HY. Isotypes of anti-beta2-glycoprotein I antibodies: association with thrombosis in patients with systemic lupus erythematosus. J Rheumatol. 2001;28(3):520–4.PubMed Lee SS, Cho ML, Joo YS, Kim WU, Hong YS, Min JK, Lee SH, Park SH, Cho CS, Kim HY. Isotypes of anti-beta2-glycoprotein I antibodies: association with thrombosis in patients with systemic lupus erythematosus. J Rheumatol. 2001;28(3):520–4.PubMed
15.
go back to reference Staub HL, Franck M, Ranzolin A, Norman GL, Iverson GM, von Muhlen CA. IgA antibodies to beta2-glycoprotein I and atherosclerosis. Autoimmun Rev. 2006;6(2):104–6.CrossRefPubMed Staub HL, Franck M, Ranzolin A, Norman GL, Iverson GM, von Muhlen CA. IgA antibodies to beta2-glycoprotein I and atherosclerosis. Autoimmun Rev. 2006;6(2):104–6.CrossRefPubMed
16.
go back to reference Murthy V, Willis R, Romay-Penabad Z, Ruiz-Limon P, Martinez-Martinez LA, Jatwani S, Jajoria P, Seif A, Alarcon GS, Papalardo E, et al. Value of isolated IgA anti-beta2 -glycoprotein I positivity in the diagnosis of the antiphospholipid syndrome. Arthritis Rheum. 2013;65(12):3186–93.CrossRefPubMedPubMedCentral Murthy V, Willis R, Romay-Penabad Z, Ruiz-Limon P, Martinez-Martinez LA, Jatwani S, Jajoria P, Seif A, Alarcon GS, Papalardo E, et al. Value of isolated IgA anti-beta2 -glycoprotein I positivity in the diagnosis of the antiphospholipid syndrome. Arthritis Rheum. 2013;65(12):3186–93.CrossRefPubMedPubMedCentral
17.
go back to reference Staub HL, Norman GL, Crowther T, Da CV, Polanczyk A, Bohn JM, Fernandes JG, Chahade WH, von Muhlen CA: Antibodies to the atherosclerotic plaque components beta2-glycoprotein I and heat-shock proteins as risk factors for acute cerebral ischemia. Arq Neuropsiquiatr 2003, 61(3B):757–763. Staub HL, Norman GL, Crowther T, Da CV, Polanczyk A, Bohn JM, Fernandes JG, Chahade WH, von Muhlen CA: Antibodies to the atherosclerotic plaque components beta2-glycoprotein I and heat-shock proteins as risk factors for acute cerebral ischemia. Arq Neuropsiquiatr 2003, 61(3B):757–763.
18.
go back to reference Tortosa C, Cabrera-Marante O, Serrano M, Martinez-Flores JA, Perez D, Lora D, Morillas L, Paz-Artal E, Morales JM, Pleguezuelo D, et al. Incidence of thromboembolic events in asymptomatic carriers of IgA anti ss2 glycoprotein-I antibodies. PLoS One. 2017;12(7):e178889.CrossRef Tortosa C, Cabrera-Marante O, Serrano M, Martinez-Flores JA, Perez D, Lora D, Morillas L, Paz-Artal E, Morales JM, Pleguezuelo D, et al. Incidence of thromboembolic events in asymptomatic carriers of IgA anti ss2 glycoprotein-I antibodies. PLoS One. 2017;12(7):e178889.CrossRef
19.
go back to reference Rubbert A, Bock E, Schwab J, Marienhagen J, Nusslein H, Wolf F, Kalden JR. Anticardiolipin antibodies in HIV infection: association with cerebral perfusion defects as detected by 99mTc-HMPAO SPECT. Clin Exp Immunol. 1994;98(3):361–8.CrossRefPubMedPubMedCentral Rubbert A, Bock E, Schwab J, Marienhagen J, Nusslein H, Wolf F, Kalden JR. Anticardiolipin antibodies in HIV infection: association with cerebral perfusion defects as detected by 99mTc-HMPAO SPECT. Clin Exp Immunol. 1994;98(3):361–8.CrossRefPubMedPubMedCentral
20.
go back to reference Chow FC, He W, Bacchetti P, Regan S, Feske SK, Meigs JB, Grinspoon SK, Triant VA. Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort. Neurology. 2014;83(19):1705–11.CrossRefPubMedPubMedCentral Chow FC, He W, Bacchetti P, Regan S, Feske SK, Meigs JB, Grinspoon SK, Triant VA. Elevated rates of intracerebral hemorrhage in individuals from a US clinical care HIV cohort. Neurology. 2014;83(19):1705–11.CrossRefPubMedPubMedCentral
21.
go back to reference Durand M, Sheehy O, Baril JG, LeLorier J, Tremblay CL. Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study. J Stroke Cerebrovasc Dis. 2013;22(7):e34–41.CrossRefPubMed Durand M, Sheehy O, Baril JG, LeLorier J, Tremblay CL. Risk of spontaneous intracranial hemorrhage in HIV-infected individuals: a population-based cohort study. J Stroke Cerebrovasc Dis. 2013;22(7):e34–41.CrossRefPubMed
Metadata
Title
Multimodal computed tomography-guided intravenous rtPA for aborted stroke in a HIV-infected young man: a case report
Authors
Ping Liu
Min Wu
Ning Zhang
Chunyou Chen
Bing Xiong
Xiaoying Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2018
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-018-3357-5

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