Undiagnosed 33-Year-Old Filipino Male HIV Case Presenting Initially as Stroke in the Young: A Case Report

Samantha Karla DV Inoncillo, Joseree-Ann S. Catindig, Maria Rhona M. Bergantin

Apr 2026 DOI 10.35460/2546-1621.2025-0086     Access   

Abstract

Cerebrovascular disease is uncommon in patients with HIV, occurring in up to 1.9% of patients, 0.2% were presenting with transient ischemic attacks. The central nervous system is the first part of the body to be affected by the human immunodeficiency virus. This case report is a unique presentation of a 33-year-old male who presented with focal neurologic deficits that lasted for one hour with a background of promiscuous history. The patient was positive for HIV screening test and CD4 count and was started on a combination of antiretroviral therapy. This is the first documented case report in the Philippines. This case report demonstrates the need for a high index of suspicion for early detection of the cause in HIV-positive patients with recurrent transient ischemic attacks, given the high morbidity and mortality that is associated with this condition if delayed or undiagnosed.

 

Key Words: Recurrent Transient Ischemic Attack, Immunocompromised Host, Acquired Immunodeficiency Syndrome, Human Immunodeficiency Syndrome, Cerebral Small Vessel Disease

  1. Price RW, Brew BJ. Central and peripheral nervous system complications. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. AIDS: Etiology, diagnosis, treatment, and prevention. Philadelphia: Lippincott-Raven; 1997. p. 331–53.
  2. Said G, Saimot AG, Tardieu M, Lacroix C. Introduction. In: Warlow CP, editor. Neurological complications of HIV and AIDS. London, England: W B Saunders; 1997. p. 1–3.
  3. Berger JR, Moskowitz L, Fischl M, Kelley RE. Neurologic disease as the presenting manifestation of acquired immunodeficiency syndrome. South Med J [Internet]. 1987;80(6):683–6. Available from: http://dx.doi.org/10.1097/00007611-198706000-00004
  4. Pinto AN. AIDS and cerebrovascular disease. Stroke [Internet]. 1996;27(3):538–43. Available from: http://dx.doi.org/10.1161/01.str.27.3.538 
  5. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol [Internet]. 2013;12(8):822–38. Available from: http://dx.doi.org/10.1016/S1474-4422(13)70124-8. PMID: 23867200. 
  6. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol [Internet]. 2010;9(7):689–701. Available from: http://dx.doi.org/10.1016/S1474-4422(10)70104-6. PMID: 20610345.
  7. Rouhl RPW, Damoiseaux JGMC, Lodder J, Theunissen ROMFIH, Knottnerus ILH, Staals J, et al. Vascular inflammation in cerebral small vessel disease. Neurobiol Aging [Internet]. 2012;33(8):1800–6. Available from: http://dx.doi.org/10.1016/j.neurobiolaging.2011.04.008 
  8. Shoamanesh A, Preis SR, Beiser AS, Vasan RS, Benjamin EJ, Kase CS, et al. Inflammatory biomarkers, cerebral microbleeds, and small vessel disease: Framingham Heart Study. Neurology [Internet]. 2015;84(8):825–32. Available from: http://dx.doi.org/10.1212/WNL.0000000000001279 
  9. Evers S, Nabavi D, Rahmann A, Heese C, Reichelt D, Husstedt I-W. Ischaemic cerebrovascular events in HIV infection: a cohort study. Cerebrovasc Dis [Internet]. 2003;15(3):199–205. Available from: http://dx.doi.org/10.1159/000068828 
  10. Cole JW, Pinto AN, Hebel JR, Buchholz DW, Earley CJ, Johnson CJ, et al. Acquired immunodeficiency syndrome and the risk of stroke. Stroke [Internet]. 2004;35(1):51–6. Available from: http://dx.doi.org/10.1161/01.STR.0000105393.57853.11 
  11. Benjamin LA, Bryer A, Lucas S, Stanley A, Allain TJ, Joekes E, et al. Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies: Defining and classifying etiology for research studies. Neurol Neuroimmunol Neuroinflamm [Internet]. 2016;3(4):e254. Available from: http://dx.doi.org/10.1212/NXI.0000000000000254 
  12. Sanford R, Strain J, Dadar M, Maranzano J, Bonnet A, Mayo NE, et al. HIV infection and cerebral small vessel disease are independently associated with brain atrophy and cognitive impairment. AIDS [Internet]. 2019;33(7):1197–205. Available from: http://dx.doi.org/10.1097/QAD.0000000000002193 

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.