Intracranial aneurysms can occur in association with HIV infection in both adults and children, clinicians from South Africa report in the January 2008 issue of the Journal of Neurology, Neurosurgery and Psychiatry.

In the journal, Dr. Girish Modi and colleagues describe their experience with three black South African HIV-positive patients, between 29 and 59 years of age, with intracranial fusiform aneurysms affecting blood vessels in and around the circle of Willis.

"We have not seen many HIV patients with intracranial aneurysms and the prevalence in our HIV patient population remains as yet unknown," Dr. Modi, from the University of Witwatersrand, Johannesburg, told Reuters Health.

Clinical manifestations in the three patients were dementia, subarachnoid hemorrhage, and tonic-clonic seizures.

The characteristics of the intracranial aneurysms "suggest that they are distinctive and not a chance or coincidental co-occurrence of congenital or arteriosclerotic aneurysms," Dr. Modi and colleagues note in their report.

Two of the three patients had been diagnosed with pulmonary TB prior to the detection of intracranial aneurysm and the third was treated for presumed TB meningitis, suggesting that "infectious illnesses may be the aetiological link between HIV and aneurysms," the authors write.

In a MEDLINE-based search using the terms HIV and aneurysms, the researchers identified 17 reports of predominantly fusiform intracranial aneurysms in HIV-infected children. In adults, only 11 HIV-positive patients with intracranial aneurysms have been described.

"Extracranial aneurysms," Dr. Modi commented, "appear more frequently" in association with HIV infection. "We also do not definitely know but suspect (based on an autopsy report) that they are likely to be due to infection of the vascular wall by HIV itself (i.e., a vasculopathy caused by HIV).