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His CD4 count had been below 50 cells\/\u03bcL for 4 years but had abruptly risen to more than 250 cells\/\u03bcL. Computed tomographic and magnetic resonance imaging scans showed cerebral aneurysms and new cerebral lesions consistent with ischemic strokes. The presentation during immune reconstitution suggests that cerebral aneurysms in pediatric patients with acquired immune deficiency syndrome can result from an immune-mediated response to chronic vascular infection. 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