CEREBRAL-ISCHEMIA IN PATIENTS WITH HEPATITIS-C VIRUS-INFECTION AND MIXED CRYOGLOBULINEMIA

We describe two women (ages 35 and 36 years) with cerebral ischemia, h epatitis C virus, and mixed cryoglobulinemia. One patient (case 1) was in otherwise good health when left parietal cerebral infarction devel oped, and she was found to have narrowing of the supraclinoid internal carotid artery siphon, anterior cerebral artery A1, and middle cerebr al artery M1 segments bilaterally. Subsequent evaluation revealed abno rmal liver enzymes, mixed cryoglobulinemia (type III), hypocomplemente mia, and a high positive test result for rheumatoid factor. In the oth er patient (case 2), cerebral ischemia and seizures developed in the s etting of previously documented mixed cryoglobulinemia (type II), memb ranoproliferative glomerulonephritis, and hypocomplementemia. In this patient, a brain biopsy demonstrated cerebral infarction. Hepatitis C virus infection was confirmed in both patients by polymerase chain rea ction detection of hepatitis C virus RNA. These two cases document the occurrence of cerebral ischemia in patients with hepatitis C virus in fection and mixed cryoglobulinemia. Testing for hepatitis C virus and cryoglobulins should be considered in selected patients with cerebral ischemia of inobvious cause.