The occurrence and causes of stroke in children with acquired inmunodeficiency syndrome are reported from the Albert Einstein College of Medicine, Bronx, and the State University of New York at Stony Brook, NY. The report includes seven children with HIV infection who had clinical evidence, pathological evidence or both of stroke. An estimate of the clinical incidence of stroke based on four of 68 cases followed in a longitudinal study for 4½ years was 1.3% per year. Of the seven children with stroke, four had hemorrhage in the CNS and six had non-hemorrhagic infarcts. The prevalence of cerebrovascular disease in a consecutive autopsy series was higher than the clinical incidence and was documented in six (24%) of 25 children with HIV infection, including those children who had clinical evidence of stroke. In four children with immune thrombocytopenia, hemorrhage was catastrophic in one and clinically silent in three. Arteriopathy of meningocerebral arteries and aneurysmal dilatation of the circle of Willis were found in two patients, and two had co-existing cardiomyopathy and subacute necrotizing encephalomyopathy. [1]

COMMENT. In children with AIDS who develop focal neurological signs, cerebrovascular disease and stroke are likely explanations. The most frequent CNS complications of HIV-1 infection in children are developmental delays, cognitive impairment, acquired microcephaly, and bilateral corticospinal tract signs. Movement disorders and cerebellar signs are less frequent and seizures are uncommon. [2, 3]