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Central nervous system vasculitis associated with hepatitis C virus infection: a brain MRI-supported diagnosis

A Castro Caldas1, R Geraldes2, L Neto2

  • 1Department of Neurosciences, Stroke Unit, Hospital de Santa Maria, Portugal.

Journal of the Neurological Sciences
|November 12, 2013
PubMed

Insights

Hepatitis C virus (HCV) infection rarely involves the central nervous system (CNS). This case highlights CNS vasculitis in an HCV patient, requiring specific treatment for recovery.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • Hepatitis C virus (HCV) infection is linked to diverse extrahepatic manifestations.
  • Central Nervous System (CNS) involvement in HCV is uncommon.

Observation:

  • A 54-year-old man with hypertension presented with neurological deficits including headache, apathy, somnolence, and left hemiparesis.
  • Brain MRI revealed acute and old ischemic lesions, with gadolinium enhancement suggesting active vasculitis in cerebral arteries.
  • Laboratory tests confirmed high HCV viral load, elevated inflammatory markers, and cerebrospinal fluid abnormalities, excluding other infections.

Findings:

  • Cerebral angiography confirmed irregularities and stenosis consistent with vasculitis.
  • The patient showed clinical and imagiological improvement after treatment with pegylated interferon alpha-2a, ribavirin, and corticotherapy.

Implications:

  • This case underscores the rare but critical association between HCV infection and CNS vasculitis.
  • Prompt investigation and specific antiviral and anti-inflammatory therapy are crucial for managing this condition.
Abstract

Keywords:
CNS vasculitisGadolinium MRIGadolinium enhanced blood vesselsHCV infectionSteroid treatmentStroke

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