What happened that resulted in a CVA?

It may be related to the hypercoagulable state seen with some HIV patients. She had no evidence of valvular heart disease, at least as could be determined by auscultation. Paradoxical embolization is possible, but the source is not clear.

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The differential diagnosis should include:

• Toxoplasmosis
• CNS lymphoma or other malignancy.
• Embolic event from endocarditis or atrial clot.
• Paradoxical embolus.
• If febrile, include
• Meningitis and
• Cerebral malaria

How does one manage thrombembolic disease in an HIV-infected patient?