South African Journal of Radiology

Objectives: To describe the radiological appearance of intracranial aneurysms in HIV-positive adults.

Method: In this retrospective analysis of data, 23 HIV-positive patients, of which 15 (65.2%)were female, with a total of 41 aneurysms were included. The mean age was 38 years, and their median CD4 count was 305 x 106/L. Inclusion criteria comprised subarachnoid haemorrhage and confirmed intracranial aneurysms on four-vessel angiography.

Results: Fifteen (65.2%) patients had a single aneurysm, of which 12 (80.0%) had a saccular appearance. Seven (46.7%) of the single aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.9 mm and the transverse diameter 4.4 mm. More than half of these aneurysms occurred at the anterior communicating artery. The median CD4 count of single-aneurysm patients was 319 x 106 /L. Eight patients (34.8%) had multiple aneurysms, with a total of 26 aneurysms (range 2–6 aneurysms per patient), of which 13 (50.0%) had a complex appearance. Twenty-four (92.3%) of the multiple aneurysms had a neck width larger than 50% of the transverse aneurysm sac size. The mean longitudinal diameter of the aneurysm sac was 4.0 mm and the transverse diameter 3.9 mm. The multiple aneurysms occurred more commonly in the internal carotid artery. These patients had a median CD4 count of 294 x 106/L.

Conclusion: HIV-associated intracranial aneurysms occur at a younger age, appear to be saccular and complex in shape, with a wide neck, and might rupture at small sizes.