Transient ischemic attack associated with acute cytomegalovirus infection

Abstract

Acute cytomegalovirus (CMV) infection is associated with thromboembolism. However, cerebrovascular ischemic events have not been reported in relation to acute CMV infection. A patient with a transient ischemic attack and acute CMV infection is described. Transient appearance of anti-phospholipid antibodies suggests a causal relationship between the two. Physicians should be alert to symptoms and signs of acute CMV infection in patients with idiopathic cerebrovascular ischemic events.

State of the art paper Thrombosis associated with acute cytomegalovirus infection: a narrative review

“…The most accepted theory indicates that acute CMV infection is associated with transient appearance of anti-phospholipid antibodies. This theory has been demonstrated in vitro [ 30 ] as well as in vivo several times [ 10 , 11 , 15 , 31 – 37 ]. According to Schimanski et al .…”

“…Since acute CMV infection is associated with transient appearance of anti-phospholipid antibodies [ 10 , 11 , 15 , 20 , 30 – 37 ], we believe that CMV serology tests should be carried out in thrombosis patients with anti-phospholipid antibodies. Anti-phospholipid antibody serology tests should also be repeated a few months later in order to determine whether seropositivity is transient or permanent.…”

“…However, the association between arterial thromboses and acute CMV infection is questionable [ 22 ]. Indeed, arterial thromboses associated with acute CMV infection have been seldom reported in the literature [ 2 ] and include: renal infarct and renal artery thrombosis ( n = 2; 1.8%), stroke ( n = 2; 1.8%), myocardial infarction ( n = 1; 0.9%), and digital ischemia ( n = 1; 0.9%) [ 7 , 11 , 21 , 32 , 41 , 42 ]. Splenic infarct, reported 13 (11.5%) times in the literature [ 1 – 18 ], may be attributed to arterial insufficiency associated with rapid splenic growth, but it may also be associated with arterial embolism [ 43 , 44 ].…”

Cytomegalovirus‐associated cerebral sinus vein thrombosis

“…Cytomegalovirus (CMV)‐associated thrombosis has been reported more than 100 times in the medical literature thus far. Most reported patients had CMV‐associated venous thromboembolism, that is, lower limb deep vein thrombosis and/or pulmonary embolism [Justo et al, 2011; Novelli et al, 2011; Schreiner et al, 2011; Amit et al, 2012; Poon et al, 2012]. CMV‐associated cerebral sinus vein thrombosis has been reported only twice: one patient had Human Immunodeficiency Virus (HIV) [Meyohas et al, 1989] and the other patient took oral contraceptives [Slooter et al, 2002].…”

Anticardiolipin antibodies‐associated stroke in primary CMV infection

“…Secondly, thrombosis has been described in 6.7% of primary CMV infection, including two intra-cranial venous thrombosis [4], as well as some cases of APS associated with CMV infection along with thrombotic events [2,8]. In such cases thrombosis was located in mesenteric, femoropopliteal and iliac veins, but digital arteries thrombosis, pulmonary embolism and transient ischaemic attack have also been reported [9]. Moreover, a mice model of APS has demonstrated a molecular mimicry with CMV-derived peptides in induction of aCLs associated with thrombosis.…”