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Transient Cerebral Arteriopathy in a Child Associated With Cytomegalovirus Infection
Wei-Tsun Kao1, Wei-Chen Lin2, Yong-Hao Tseng1
1Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Insights
Cytomegalovirus (CMV) infection can cause transient cerebral arteriopathy, a type of childhood stroke. Prompt treatment with antivirals and anti-inflammatories led to clinical improvement and stabilized arterial lesions in an immunocompetent child.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Vascular wall injuries are a leading cause of childhood stroke.
- Transient cerebral arteriopathy, linked to infections, is an emerging cause of pediatric stroke.
- Cerebral arteriopathy involves inflammation of cerebral arteries.
Purpose of the Study:
- To report the first case of cytomegalovirus-associated transient cerebral arteriopathy in an immunocompetent child.
- To highlight the role of cytomegalovirus in pediatric cerebrovascular disease.
Main Methods:
- A case report of a 2.5-year-old girl with sudden hemiplegia and aphasia.
- Neuroimaging revealed right middle cerebral artery occlusion and ischemic damage.
- Laboratory tests confirmed cytomegalovirus infection in cerebrospinal fluid and serum.
Main Results:
- The patient presented with acute neurological deficits.
- Cytomegalovirus infection was confirmed.
- Treatment with ganciclovir, immunoglobulin, and prednisolone, followed by aspirin, resulted in clinical improvement.
- Follow-up imaging showed stabilized arterial lesions without stenosis.
Conclusions:
- Cytomegalovirus can cause transient cerebral arteriopathy in immunocompetent children.
- This case underscores the importance of considering CMV in pediatric stroke evaluations.
- Early diagnosis and treatment are crucial for managing CMV-associated arteriopathy.
Abstract:
Vascular wall injuries account for up to 80% of childhood strokes, excluding emboli of cardiac origin. Transient cerebral arteriopathy is a recently described entity that is increasingly recognized as an important cause. The cerebral arterial wall is thought to be affected by an inflammatory process related to certain infections. The authors report a 2.5-year-old girl with sudden left hemiplegia and aphasia. The neuroimaging showed occlusion of the right middle cerebral artery and ischemic damages. Laboratory revealed positive cytomegalovirus immunoglobulin M and G in cerebrospinal fluid and in early and late sera. Treatment with ganciclovir, anticytomegalovirus immunoglobulin, and prednisolone, followed by oral aspirin, resulted in clinical improvement. The follow-up neuroimaging showed stabilization of the arterial lesions without residual stenosis. To our knowledge, this is the first report of a cytomegalovirus-associated transient cerebral arteriopathy in an immunocompetent child. Our report demonstrates the propensity for cytomegalovirus to be involved in pediatric cerebral vascular disease.
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