Stroke and HIV in Botswana: A prospective study of risk factors and outcomes

OBJECTIVE

HIV is associated with an increased risk of stroke, but there are sparse data on risk factors for stroke in people living with HIV in Sub-Saharan African. The goal of this study was to identify HIV-specific stroke characteristics and risk factors among adults in Botswana.

METHODS

We conducted a prospective cohort study in Gaborone, Botswana from June 2015 to June 2017 comparing risk factors and outcomes among adults with and without HIV admitted for acute stroke. In addition, we conducted a case-control study comparing patients with HIV and stroke to outpatients with HIV and no history of stroke.

RESULTS

A total of 52 patients with imaging-confirmed acute stroke were enrolled. Stroke patients with HIV were younger than those without HIV (median age 40 vs 54, p = .005). Hypertension was the most common risk factor identified in both HIV+ and HIV- groups, but was more common in patients without HIV (81% vs. 55%, p = .04). Patients with HIV were significantly more likely to have a small-vessel lacunar syndrome compared to patients without HIV (67% vs. 29%, p = .02). In the case-control analysis, patients with HIV and stroke were more likely to have hypertension than stroke-free controls (53% vs. 16%; OR 7.2, 95% CI 1.5-33.8, p = .01), and were more likely to drink alcohol (53% vs. 21%, OR 3.7, 95% CI 1.1-12.1, p = .03).

CONCLUSIONS

Individuals with HIV present with strokes at younger ages than individuals without HIV. Among those with HIV, hypertension and alcohol use are significant risk factors for stroke.

Cavernous sinus thrombosis in a 14-year old boy

Mokgacha K, Maruza MP, Sesay SO, Rwegerera GM. Cavernous sinus thrombosis in a 14-year old boy. Turk J Pediatr 2017; 59: 719-723. Cavernous sinus thrombosis (CST) is a rare, life-threatening disorder occurring as a result of sepsis or secondary to aseptic causes in the setting of a thrombophilic disorder that has over the years been linked to high morbidity and mortality rates; this being despite availability of a wide number of new broad-spectrum antibiotics. We present a case of a 14-year old boy who had presented with two weeks` duration of worsening bitemporal headache followed by facial swelling on the background history of chronic non-specific headache of few months duration. He was diagnosed to have cavernous sinus thrombosis secondary to pansinusitis. The course of his illness was complicated by a stroke despite prompt treatment with antibiotics and anticoagulation. The case highlights the importance of high index of suspicion in patients with unexplained headache and need for investigation and early referral to prevent occurrence of cavernous sinus thrombosis.