Since its identification in 1989,
hepatitis C has been implicated in the pathogenesis of an increasing number of diseases previously believed to be primary or idiopathic. We report 2 rarely seen cases of isolated central nervous system (
CNS) vasculitis in patients with
hepatitis C infection. Patient 1. A 43-year-old man with 4 day right temporal
headache developed a left
hemiparesis. Weakness was his only physical finding. Computed tomography (CT) scan demonstrated a large right frontotemporal
hemorrhage, and angiography revealed focal dilatations and irregularities of multiple branches of the right middle and anterior cerebral arteries. Cerebral
decompression was performed and leptomeningeal biopsies showed
granulomatous angiitis. Laboratory results were normal except for elevated liver biochemical tests. Later testing for
hepatitis C was positive. His neurological symptoms improved with
corticosteroids and
cyclophosphamide. Patient 2. A 39 yr old male developed 3 days of left sided weakness, slurred speech and difficulty swallowing fluids. Physical findings were limited to his weakness. Magnetic resonance imaging demonstrated a right superior pontine subacute
infarct with a small left internal capsule
lacunar infarct. Angiography revealed multiple areas of focal narrowing with no areas of abrupt vessel cut off. Cerebral spinal fluid showed 71 PMN, 29 RBC, normal
glucose, elevated
protein (64 mg/dl), no
oligoclonal bands, and low
myelin basic protein. Other laboratory analyses were normal including liver biochemical tests. However,
hepatitis C serology was positive and mixed
cryoglobulins were detected.
CNS vasculitis was diagnosed and nearly full recovery was achieved with
corticosteroids,
cyclophosphamide and
warfarin.