[Essential mixed cryoglobulinemia as a cause of ischemic cerebrovascular accident]

Involvement of the central nervous system in patients with essential mixed cryoglobulinaemia is rare, and there are few cases described in the medical literature. Moreover, the mechanism by which lesions are produced in the central nervous system is still not clear.

We describe the case of a 35 year old woman who presented with dysarthria, weakness and paraesthesia of her left limbs and left central facial paralysis of sudden onset. Vascular studies showed the presence of IgG-IgM polyclonal positive cryoglobulins and polymerase chain reaction (PCR) showed hepatitis C virus to be present. Cerebral magnetic resonance showed ischemic lesions in the tail of the right caudate nucleus and right corona radiata and the posteromedial part of the right putamen. Other investigations were negative or normal.

In young patients with cerebral vascular pathology the possibility of hepatitis C and essential mixed cryoglobulinemia should be considered, especially when the transaminases are raised as in our patient. We consider that the physiopathological mechanisms must be related to factors which determine a prothrombotic state in the arterial bed involved.