Restoring the immune system as captured by the CD4 count is indicated in all patients with HIV regardless of whether they have stroke.717 CLINICAL STATEMENTS AND GUIDELINES Kleindorfer The presence of stroke may be seen as an even greater indication to treat the most devastating consequences of HIV infection and associated immunosuppression. Observational data support this approach in patients with HIV vasculopa- Some authors have noted a possible link between the initiation of combined antiret- roviral therapy and stroke risk, suggesting an immune reconstitution-like syndrome in these It is uncertain whether steroids may play a role in stroke risk reduction in this clinical setting. 5.13.3. Neoplastic Vasculitis Synopsis Neoplastic vasculitis refers to inflammation of the brain arteries resulting from direct invasion of neoplastic cells, as opposed to paraneoplastic vasculitis in which the inflammation of the brain arteries is not attributable to direct tumor invasion or compression. Conditions in this category are rare and include lymphomatoid granu- lomatosis and angiotropic or intravascular lymphoma (also known as angioendotheliomatosis)736 among other even less common disorders.737,738 Treating the underlying malignancy also reduces the risk of recur- rent stroke. The relatively rare occurrence of neoplastic vasculitis is a challenge for the systematic study of the disease. Even less homogeneous information exists on what strategy may be the most effective to reduce the risk of stroke recurrence thought to be attributable to a neoplastic vasculitis. Angiotropic lymphoma is perhaps the most commonly reported neoplastic vasculitis in the literature. In a large meta-analysis of cases of angiotro- pic lymphoma reported between 1957 and 2012, only 8% presented with stroke-like symptoms.736 Given the observational nature of the report, limited information is available on how to reduce the risk of stroke recur- rence. Therefore, we advise treating the underlying malignancy. 