Cerebral venous thrombosis and hepatitis: case report

Abstract

-Among the many infective causes of cerebral venous thrombosis (CVT), viral hepatitis is been re g a rded as a rare associated condition. We re p o rt on a 56-years-old man presenting CVT associated with hepatitis B and C coinfections outlining probable pathogenic mechanisms. We suggest that virus B and C serology should be performed in the cases of cerebral venous thrombosis with unknown etiology.KEY WORDS: cerebral venous thrombosis, hepatitis B virus, hepatitis C virus.Trombose venosa cerebral e hepatite: relato de caso RESUMO -Dentre as várias causas infecciosas de trombose venosa cerebral (TVC), a hepatite viral tem sido reconhecida como causa rara de TVC. Relatamos sobre um homem de 56 anos com TVC associada a coinfecção pelos vírus B e C da hepatite, ressaltando possíveis mecanismos patogênicos. Sugerimos que soro l ogia para vírus da hepatite B e C deveria ser solicitado em todos os casos de TVC de origem indeterm i n a d a . PALAVRAS-CHAVE: trombose venosa cerebral, vírus da hepatite B, vírus da hepatite C.The main recognized causes or predisposing conditions to cerebral venous thrombosis (CVT) can be divided into two groups: infectious (either local or systemic) and non-infectious causes 1 -3 . There is also a third group without specific etiology, which may c o rrespond to 20% to 35% of the total causes 4 . C h ronic hepatitis C virus (HCV) infection has been c o n s i d e red as a rare cause of cerebral venous thro mbosis 5-10 . We re p o rt a case of such association and discuss possible physiopathogenic mechanisms. CASEA 56-year-old white man was admitted to our hospital with a 15-day history of headache worsening with considerable change in its frequency and intensity patterns. He was a chronic daily headache suff e rer taking amitry p t i l i n e 75 mg and propranolol 80 mg per day and had already taken several abortive treatment regimens. Four days before admission he had two episodes of focal motor seizure. His past history included heavy smoking and drinking. He took intravenous cocaine for 20 years until 12 years ago. He also had occasional bisexual relations. General physical examination was unremarkable. Neurological exam abnorm a l ities included left mild hemiparesis. Pain relief medication was initiated as well as carbamazepine 600 mg per day.Routine blood and urine exams were unremarkable. On c e rebral spinal fluid (CSF) the initial pre s s u re was 33 cm/H 2 O with cell count and biochemistry within normal parameters.Chest radiograph was normal such as cranial computed tomography scan (CT). Cranial magnetic resonance imaging (MRI) indicated superior sagittal and left transverse sinuses thrombosis associated to corpus callosum and right parietal hemorrhagic venous infarcts. New blood sample was taken in order to investigate pos sible secondary e tiologies and on that time venous non-fractionated heparin was initiated.Values of serum immunoglobulins were: IgA=151 mg/dL (78-367 mg/dL), IgG=703 mg/dL (583-1761 mg/dL) and IgM= 69 mg/dL (52-335 mg/dL). The following autoantibodi...

Risk Factors of Cerebral Vein and Sinus Thrombosis

“…Numerous agents have been reported (table 2) and include bacteria (Mycobacterium tuberculosis [101][102][103][104], Mycoplasma pneumoniae [105], Burkholderia pseudomallei [106], Fusobacterium necrophorum [107][108][109], and Salmonella paratyphi [110]), viruses (measles [111], varicella-zoster virus [112,113], hepatitis virus B and C [114][115][116], immunodeficiency virus [117][118][119], and cytomegalovirus [119]), spirochetae (Lepstospira interrogans [120], and Treponema pallidum [121]), parasitae (Plasmodium falciparum [122,123], and Trichinella spiralis [124,125]), and fungi (Rhizopus species [126][127][128], Aspergillus fumigatus [129][130][131][132][133][134], and Coccidioides immitis [135]). [16,76], endocarditis [76], typhoid [76], tuberculosis [101][102][103][104], Mycoplasma pneumoniae …”

Cerebral Venous Sinus Thrombosis-A Study of Clinicoaetiological Profile

“…In the NIVSAR study 11.4% had usage of OCP. Local infection (mastoiditis, CSOM & sinusitis) & meningitis were found as a risk factor in 4.8% cases .Infection as a predisposing factor has been reported by various authors [16,17,18] . Improved health awareness, hygiene & availability of antibiotic & chemotherapeutic agents has reduced the incidence of CVT in these cases.…”

Coexistent Ipsilateral Internal Carotid Artery Occlusion and Cerebral Venous Thrombosis in Hepatitis C

“…While cerebral venous thrombosis is reported in the setting of hepatitis C, and hepatitis C virus (HCV) is considered a potential risk factor for ischemic stroke, 1 from our literature search we have not found any cases with both cerebral arterial and venous thrombosis present in the setting of hepatitis C infection. With search terms “cortical vein thrombosis” and “arterial occlusion” on PubMed, coexistence of the cerebral artery occlusion and cortical vein thrombosis is described infrequently in the literature.…”