New Hypotheses on Midbrain Stroke Secondary to HIV Vasculitis and Drug Management
Author(s): Lourdes de Fatima Ibanez Valdes*, Humberto Foyaca Sibat
Abstract
Introduction: Midbrain ischemic stroke represents a condition mainly caused by an occlusion of the Posterior Cerebral Artery (PCA) branches, which are paired terminal branches of the basilar artery in the circle of Willis. PCA provides supply to most parts of the occipital cortex, the inferior and medial temporal cortices, the thalamus, and rostral midbrain. In the pre-ART era, Patients Living with HIV (PLWH) had a high risk of ischemic stroke compared to those without HIV, and the strokes occurred mostly in those with advanced AIDS, complicated with secondary infections such as fungal meningitis, toxoplasmosis encephalitis, tuberculous meningitis and neurosyphilis or those with coagulopathies or vasculitis. The main aid of this review is to report a case presenting a midbrain stroke due to HIV vasculitis and to bring more light into the pathogenesis of this condition regarding its pathogenesis on vascular occlusion and reperfusion.
Methods: A large search of the articles published in SCOPUS, and MEDLINE to identify manuscripts related to midbrain ischemic stroke related to HIV vasculitis. From 01st, January 1990 to 30th, January 2026, we comprehensively review the medical literature and selected the following issues: “HIV vasculitis” OR “midbrain stroke” OR “Weber syndrome” OR “HIV-atherosclerosis” OR “pathophysiology of occlusion/reperfusion”, OR “pathophysiologic of midbrain stroke” OR “drug management of midbrain stroke”.
Results: After searching medical publications, 407 articles were retrieved. We removed 291 duplicated titles and abstracts; 116 manuscripts are chosen. After assessing the inclusion/exclusion related to HIV-vasculitis midbrain stroke and pathogenesis of reperfusion criteria all publications were removed; finally, cero articles investigated the pathogenesis of occlusion and reperfusion of ischemic midbrain stroke secondary to HIV vasculitis.
Conclusions: Based on our comprehensive review of the medical literature, we concluded that Posterior Cerebral Artery (PCA) midbrain stroke represents a smaller proportion of IS, often results in significant neurological deficits and poses distinctive therapeutic challenges. As far as we know, this is the first study that graphically represent the elements involved in the pathogenesis of midbrain stroke secondary to HIV vasculitis and its mechanism of reperfusion at the rostral midbrain