Adult patients infected with HIV appear to be at increased risk for stroke. Stroke, however, is an uncommon complication of AIDS in pediatric patients. Although, 10-30% of children with HIV infection had evidence of cerebral infarction at autopsy, only 1% of pediatric patients with AIDS have clinical symptoms of stroke. We report a rare case of a pediatric patient with AIDS and a stroke caused by cerebellar infarction.

A 7-year old female, positive for HIV presented with sudden onset of dysarthria and ataxia. Her past medical history included multiple hospitalizations for pneumonia and lymphocytic interstitial pneumonitis. Physical examination showed an afebrile, alert girl with an ataxic gait. There was no nystagmus. Neurologic examination revealed incordinate movements which affected her right side: deep tendon reflexes were brisk in all four extremities.

Laboratory examination was normal, blood and urine analyses were negative: PT, PTT were within normal limits. Spinal fluid was negative. A non-enhanced axial computed tomography scan of the head showed low attenuation lesions in the left cerebellar hemisphere's infereo-lateral aspect. A magnetic resonance imaging scan of the head confirmed the lesion with a high T2-weighted signal intensity. These findings are consistent with a left inferior cerebellar artery stroke.

Since our patient had no evidence of infection, lymphoma, or opportunistic infections, we believe that the cerebellar infarction was due to the primary infection by the HIV virus itself. Cerebrovascular accidents must be considered in the work-up of children with AIDS who present with focal neurological deficits.