Abstract TP477: Vessel Diameter, Brain Perfusion and Small Vessel Disease Burden in HIV+ Population and Controls

Cerebral small vessel disease (CSVD) in patients with HIV is a subject of ongoing study in regard to the effect of HIV infection on cerebral vessels. In our cohort of HIV+ (on stable cART for at least 12 weeks) and age-matched controls, we investigated the relationship between HIV status and extracranial large vessel diameter, burden of white matter hyperintensities (WMH), as well as cerebral blood flow (CBF). Subjects underwent MRI including an arterial spin labeling (ASL) sequence to calculate CBF and MRA to measure arterial diameters. Arterial diameter and regional CBF were used as outcome variables in multivariate regression models incorporating HIV status, hypertension, WMH burden, age, and Reynold score. Partial correlations were performed to assess the relationship strength between CBF and vessel diameter. Extracranial vessel diameter means were significantly different between HIV+ and HIV- cohorts after controlling for age, Reynold score, WMH, hypertension, and regional CBF means. CBF was not significantly different in the presence of HIV, nor WMH. However, hypertension and age were significantly associated with CBF in multivariate regression analysis. Extracranial vessel diameter and WMH were not significantly related. Accounting for HIV status did not affect this correlation. Extracranial large vessel diameter (0.3) and age (0.6) were strongly and significantly partially correlated with CBF. There appears to be a relationship between HIV status and caliber of extracranial vessels, suggesting possible effect of HIV on large vessel health. Vessel diameter and WMH may be related due to similar risk factors, however, further study is needed at this time. As expected, large vessel diameter correlated with perfusion metrics and age. Future directions include a volumetric assessment of WMH and assessments of the relationship between markers of platelets and endothelial dysfunction.

A Case of Polyarteritis Nodosa Associated with Vertebral Artery Vasculitis Treated Successfully with Tocilizumab and Cyclophosphamide

Pediatric polyarteritis nodosa is rare systemic necrotizing arteritis involving small- and medium-sized muscular arteries characterized by aneurysmal dilatations involving the vessel wall. Aneurysms associated with polyarteritis nodosa are common in visceral arteries; however intracranial aneurysms have also been reported and can be associated with central nervous system symptoms, significant morbidity, and mortality. To our knowledge extracranial involvement of the vertebral arteries has not been reported but has the potential to be deleterious due to fact that they supply the central nervous system vasculature. We present a case of a 3-year-old Haitian boy with polyarteritis nodosa that presented with extracranial vessel involvement of his vertebral arteries. After thorough diagnostic imaging, including a bone scan, ultrasound, Magnetic Resonance Imaging/Angiography, and Computed Tomography Angiography, he was noted to have vertebral artery vasculitis, periostitis, subacute epididymoorchitis, arthritis, and myositis. He met diagnostic criteria for polyarteritis nodosa and was treated with cyclophosphamide, methylprednisolone, and tocilizumab, which resulted in improvement of his inflammatory markers, radiographic findings, and physical symptoms after treatment. To the authors’ knowledge, this is the first report of vertebral artery vasculitis in polyarteritis nodosa as well as successful treatment of the condition using the combination cyclophosphamide and tocilizumab for this condition.

Multiple extracranial vessel injuries following closed head and neck trauma

✓ A case with multiple extracranial vessel involvement following closed head and neck trauma is described. The use of selective cerebral angiography through the femoral route as a diagnostic aid is stressed. The etiology of the neurological deficit and the role of intensive supportive care is discussed.