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.

Keywords: arteriopathy; childhood; cytomegalovirus; infection; stroke.

Figure 1.

A, T2-weighted magnetic resonance imaging showing hypersignal of the right middle cerebral artery territory. B, Magnetic resonance angiography showing an occlusion of the right middle cerebral artery (white arrow). C, Note a “puff-of-smoke” network of vessels, reminiscent of Moyamoya disease, was also depicted in the territory supplied by right lateral lenticulostriate arteries (black arrow).