VolumeVol. 64 • Number No. 2 • April - June 2026 Back

Case Report

Cerebral Aneurysmal Vasculopathy Presenting as Central Facial Palsy in a 25-Year-Old Male with Acquired Immunodeficiency Syndrome

Authors: Mary Grace A. El-estwani, Bryan Albert T. Lim

DOI: 10.65564/pjim.d393429fe0

Date of Publication: June 2026

Abstract

Introduction. Intracranial aneurysms have a global prevalence of ~2.3%, but the Human Immunodeficiency Virus (HIV)-related proportion is unclear. Acquired Immunodeficiency Syndrome (AIDS) can cause cerebral vasculopathy via direct viral endothelial injury or indirect mechanisms such as cardioembolism, coagulopathy, or non-HIV-related vasculitis. HIV-associated vasculopathy involves intracranial or extracranial vessel abnormalities unrelated to opportunistic infections or neoplasms.

Case Presentation. A 25-year-old male with AIDS, poorly compliant with efavirenz/lamivudine/tenofovir, presented with a 2-week history of facial palsy, initially treated as Bell’s palsy with prednisone. After seven days, he developed left hemiparesis, expressive aphasia, and abulia. MRI/MRA revealed fusiform and saccular aneurysms in the middle, anterior, and posterior cerebral arteries, with acute, subacute, and chronic infarcts. Cardioembolic and carotid causes were excluded. Due to high rupture risk, no surgical intervention was performed. Highly active antiretroviral therapy (HAART) was switched to dolutegravir/lamivudine/tenofovir, alongside antifungal therapy, PCP prophylaxis, and occupational therapy. At six-month follow-up, the patient remained HAART-compliant, ambulated independently, and continued rehabilitation; expressive aphasia persisted.

Conclusion. HIV-associated cerebral vasculopathy should be considered in young AIDS patients with new focal deficits, including facial palsy. Early HAART may improve short-term outcomes.

Keywords. HIV cerebral vasculopathy, AIDS, HAART, case report

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