In response to whether an HIV associated vasculopathy may be reversible,1 we describe a man with severe cognitive impairment due to an isolated HIV associated cerebral vasculopathy, likely to be a vasculitis. With initiation of highly active antiretroviral treatment (HAART), and without additional antimicrobial or immunosuppressive treatment, he made a major recovery over 6 weeks to independent living in the community.

A 49-year-old man from Zimbabwe living in the UK for 5 years presented after an unwitnessed collapse and 2 weeks of cognitive decline. He had received a course of oral corticosteroids for parotitis 2 months earlier. He had no other medical history and no conventional vascular risk factors. On examination he was encephalopathic with severe global cognitive impairment confirmed on formal psychometry. He knew his name, but all responses on the Abbreviated Mental Test Score were incorrect. Speech was very slow and he could follow some one step commands. There was right hemi-neglect and he could not stand unsupported. There were no additional neurological signs in the limbs allowing for the neglect, including normal power. He was meningitic, but not distressed, and afebrile. No ictal activity was observed. There was residual right parotid swelling. Ocular, cardiac, respiratory, abdominal, …