Transient Cerebral Arteriopathy in a Child Associated With Cytomegalovirus Infection

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.

COVID-19 and a Mysterious Case of Transient Cerebral Arteriopathy

“…Viruses like varicella-zoster virus (VZV) or cytomegalovirus (CMV) are known to be associated with transient arteriopathy. [ 2 3 4 5 ] An alternative explanation of the etiology for stroke in our case could be a similar type of transient cerebral arteriopathy in association with COVID-19 infection. We consider transient cerebral arteriopathy and not small microthrombi or emboli as the cause of stroke in our case because we could not get evidence of thrombus in any imaging, though there was a considerable area of transient vasoconstriction.…”