Cerebral ischaemic attack in asymptomatic hepatitis c virus infection

Summary: We tried to correlate the onset of the cerebral ischaemic attack accompanied by mixed cryoglobulinaemia with the asymptomatic hepatitis C virus infection. We studied a group of 12 patients with asymptomatic hepatitic C virus infection associated with ischaemic stroke (antihepatitis C virus antibodies-ELISA). Ischaemic stroke occurred in equal proportion in women and men. The patients were not aware of infection at that moment. All patients had type II mixed monoclonal cryoglobulinaemia, hypergammaglobulinemia with polyclonal IgG and monoclonal IgM, blood hyperviscosity, high level of cryocrit, rheumatoid factors-positive, and normal serum alanine aminotransferase levels, despite the replication of hepatitis C virus in infected liver cells and detection of HCV-RNA in serum, HBs antigen-negative, anti-HBs antibody-negative; anti-HCV antibody-positive, antinuclear antibodies-false positive. Immunological tests for autoantibodies, namely, anti-Sm antibody, anti-RNP antibody, anti-SS-A and -B antibodies, and anti-Scl antibody were not detectable due to a high level of serum cryoglobulin. Cryoglobulin was washed several times with an isotonic chloride solution for purification, then subjected to immunological analyses. The purified cryoglobulin contained monoclonal IgM-kappa, polyclonal IgG. Cryoglobulinemia is a risk factor of ischaemic stroke, it causes arterial thrombosis. The long-term exposure to antigens and the autoimmune background may have developed IgM anti-idiotype auto-antibody against the high level of anti-HCV IgG.