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Colegio de Medicina Interna de México.

2018, Number 6

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Med Int Mex 2018; 34 (6)

Ischemic stroke in patients with human immunodeficiency virus, an event of clinical importance

Quintero-Moreno DA

Language: Spanish
References: 44
Page: 933-945
PDF size: 456.02 Kb.


ABSTRACT

Stroke is the second and third cause of mortality and disability worldwide, respectively. Its incidence has increased in low and middle-income countries, due to infectious diseases, including HIV. The pathophysiology of ischemic stroke in this population is directly and indirectly related to the infection; indirectly, through cardioembolism and coagulopathies, such as: antiphospholipid syndrome and thrombotic thrombocytopenic purpura. With respect to the direct form, it is presented through vascular diseases as: accelerated atherosclerosis, non-atherosclerotic vasculopathy, cerebral disease of small vessels and vasculitis associated with HIV; in the latter, infectious causes are highlighted. In the clinical context, the presentation is similar in the HIV negative and positive population; generally, a focal neurological deficit is evidenced. However, they can occur atypically, with acute confusion, fever and sudden loss of consciousness; this clinical spectrum is more common in the context of HIV. In the diagnosis the Cincinnati and NIHSS scales are used in the same way as in the healthy population. In addition, cranial CT without contrast is the first diagnostic aid, together with electrocardiogram and hematological tests. The treatment is based on eliminating blood obstruction; the main method is thrombolysis by the tissue plasminogen activator. This disease is gaining strength in the population with HIV and it is important to know the existing relationship.


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