We describe two women (ages 35 and 36 years) with cerebral ischemia, hepatitis C virus,
and mixed cryoglobulinemia. One patient (case 1) was in otherwise good health when
left parietal cerebral infarction developed, and she was found to have narrowing of
the supraclinoid internal carotid artery siphon, anterior cerebral artery A1, and
middle cerebral artery Ml segments bilaterally. Subsequent evaluation revealed abnormal
liver enzymes, mixed cryoglobulinemia (type III), hypocomplementemia, and a high positive
test result for rheumatoid factor. In the other patient (case 2), cerebral ischemia
and seizures developed in the setting of previously documented mixed cryoglobulinemia
(type II), membranoproliferative glomerulonephritis, and hypocomplementemia. In this
patient, a brain biopsy demonstrated cerebral infarction. Hepatitis C virus infection
was confirmed in both patients by polymerase chain reaction detection of hepatitis
C virus RNA. These two cases document the occurrence of cerebral ischemia in patients
with hepatitis C virus infection and mixed cryoglobulinemia. Testing for hepatitis
C virus and cryoglobulins should be considered in selected patients with cerebral
ischemia of inobvious cause.
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© 1996 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
