Central nervous system involvement in hepatitis C virus cryoglobulinemia vasculitis: A multicenter case-control study using magnetic resonance imaging and neuropsychological tests

Milvia Casato, David Saadoun, Antonella Marchetti, Nicolas Limal, Christine Picq, Patrizia Pantano, Damien Galanaud, Rosario Cianci, Pierre Duhaut, Jean Charles Piette, Massimo Fiorilli, Patrice Cacoub

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Abstract

Objective. Involvement of the central nervous system (CNS) in patients with hepatitis C virus (HCV) mixed cryoglobulinemia (MC) is rare. The mechanism by which brain lesions are produced is unclear. We investigated these phenomena by clinical evaluation (neuropsychological tests) and cerebral magnetic resonance imaging (MRI) studies in patients with HCV-MC vasculitis. Methods. This prospective study included 40 patients with MC vasculitis and chronic active HCV infection (HCV RNA+), 11 HCV controls without MC, and 36 healthy controls, matched for sex and age. A battery of 10 standardized neuropsychological tests was administered by one experienced neuropsychiatrist. All patients underwent cerebral MRI investigation. Results. Twenty-four of the 27 (89%) evaluated patients with HCV-MC had a deficiency in one or more of the 10 cognitive domains examined. The most commonly involved domains were those of attention (70%), executive functions (44%), visual construction (37%), and visual spatial functions (33%). The number of impaired cognitive functions was significantly higher in patients with MC vasculitis than in HCV controls (2.18 ± 1.84 vs 0.87 ± 3.1; p <0.05). MRI analysis showed that HCV-MC patients had a higher mean number of total (7.03 ± 9.9 vs 0.90 ± 1.81 and 2.03 ± 3.1; p <0.05) and periventricular (2.4 ± 3.0 vs 0.38 ± 0.5 and 0.8 ± 1.4; p <0.05) white matter high intensity signals than HCV controls and healthy controls, respectively. Conclusion. The high frequency of impaired cognitive function and the extent of MRI brain abnormalities in patients with HCV-associated mixed cryoglobulinemia vasculitis strongly suggest specific inflammatory involvement of the CNS.

Original languageEnglish
Pages (from-to)484-488
Number of pages5
JournalJournal of Rheumatology
Volume32
Issue number3
Publication statusPublished - Mar 2005

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Cryoglobulinemia
Neuropsychological Tests
Vasculitis
Hepacivirus
Case-Control Studies
Central Nervous System
Magnetic Resonance Imaging
Cognition
Executive Function
Brain
Chronic Hepatitis C
Virus Diseases
Chronic Hepatitis
Prospective Studies
RNA

Keywords

  • Central nervous system
  • Cognitive function
  • Extrahepatic manifestations
  • Hepatitis C virus
  • Magnetic resonance imaging
  • Mixed cryoglobulinemia
  • Neuropathy, vasculitis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Central nervous system involvement in hepatitis C virus cryoglobulinemia vasculitis : A multicenter case-control study using magnetic resonance imaging and neuropsychological tests. / Casato, Milvia; Saadoun, David; Marchetti, Antonella; Limal, Nicolas; Picq, Christine; Pantano, Patrizia; Galanaud, Damien; Cianci, Rosario; Duhaut, Pierre; Piette, Jean Charles; Fiorilli, Massimo; Cacoub, Patrice.

In: Journal of Rheumatology, Vol. 32, No. 3, 03.2005, p. 484-488.

Research output: Contribution to journalArticle

Casato, M, Saadoun, D, Marchetti, A, Limal, N, Picq, C, Pantano, P, Galanaud, D, Cianci, R, Duhaut, P, Piette, JC, Fiorilli, M & Cacoub, P 2005, 'Central nervous system involvement in hepatitis C virus cryoglobulinemia vasculitis: A multicenter case-control study using magnetic resonance imaging and neuropsychological tests', Journal of Rheumatology, vol. 32, no. 3, pp. 484-488.
Casato, Milvia ; Saadoun, David ; Marchetti, Antonella ; Limal, Nicolas ; Picq, Christine ; Pantano, Patrizia ; Galanaud, Damien ; Cianci, Rosario ; Duhaut, Pierre ; Piette, Jean Charles ; Fiorilli, Massimo ; Cacoub, Patrice. / Central nervous system involvement in hepatitis C virus cryoglobulinemia vasculitis : A multicenter case-control study using magnetic resonance imaging and neuropsychological tests. In: Journal of Rheumatology. 2005 ; Vol. 32, No. 3. pp. 484-488.
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abstract = "Objective. Involvement of the central nervous system (CNS) in patients with hepatitis C virus (HCV) mixed cryoglobulinemia (MC) is rare. The mechanism by which brain lesions are produced is unclear. We investigated these phenomena by clinical evaluation (neuropsychological tests) and cerebral magnetic resonance imaging (MRI) studies in patients with HCV-MC vasculitis. Methods. This prospective study included 40 patients with MC vasculitis and chronic active HCV infection (HCV RNA+), 11 HCV controls without MC, and 36 healthy controls, matched for sex and age. A battery of 10 standardized neuropsychological tests was administered by one experienced neuropsychiatrist. All patients underwent cerebral MRI investigation. Results. Twenty-four of the 27 (89{\%}) evaluated patients with HCV-MC had a deficiency in one or more of the 10 cognitive domains examined. The most commonly involved domains were those of attention (70{\%}), executive functions (44{\%}), visual construction (37{\%}), and visual spatial functions (33{\%}). The number of impaired cognitive functions was significantly higher in patients with MC vasculitis than in HCV controls (2.18 ± 1.84 vs 0.87 ± 3.1; p <0.05). MRI analysis showed that HCV-MC patients had a higher mean number of total (7.03 ± 9.9 vs 0.90 ± 1.81 and 2.03 ± 3.1; p <0.05) and periventricular (2.4 ± 3.0 vs 0.38 ± 0.5 and 0.8 ± 1.4; p <0.05) white matter high intensity signals than HCV controls and healthy controls, respectively. Conclusion. The high frequency of impaired cognitive function and the extent of MRI brain abnormalities in patients with HCV-associated mixed cryoglobulinemia vasculitis strongly suggest specific inflammatory involvement of the CNS.",
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author = "Milvia Casato and David Saadoun and Antonella Marchetti and Nicolas Limal and Christine Picq and Patrizia Pantano and Damien Galanaud and Rosario Cianci and Pierre Duhaut and Piette, {Jean Charles} and Massimo Fiorilli and Patrice Cacoub",
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T2 - A multicenter case-control study using magnetic resonance imaging and neuropsychological tests

AU - Casato, Milvia

AU - Saadoun, David

AU - Marchetti, Antonella

AU - Limal, Nicolas

AU - Picq, Christine

AU - Pantano, Patrizia

AU - Galanaud, Damien

AU - Cianci, Rosario

AU - Duhaut, Pierre

AU - Piette, Jean Charles

AU - Fiorilli, Massimo

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N2 - Objective. Involvement of the central nervous system (CNS) in patients with hepatitis C virus (HCV) mixed cryoglobulinemia (MC) is rare. The mechanism by which brain lesions are produced is unclear. We investigated these phenomena by clinical evaluation (neuropsychological tests) and cerebral magnetic resonance imaging (MRI) studies in patients with HCV-MC vasculitis. Methods. This prospective study included 40 patients with MC vasculitis and chronic active HCV infection (HCV RNA+), 11 HCV controls without MC, and 36 healthy controls, matched for sex and age. A battery of 10 standardized neuropsychological tests was administered by one experienced neuropsychiatrist. All patients underwent cerebral MRI investigation. Results. Twenty-four of the 27 (89%) evaluated patients with HCV-MC had a deficiency in one or more of the 10 cognitive domains examined. The most commonly involved domains were those of attention (70%), executive functions (44%), visual construction (37%), and visual spatial functions (33%). The number of impaired cognitive functions was significantly higher in patients with MC vasculitis than in HCV controls (2.18 ± 1.84 vs 0.87 ± 3.1; p <0.05). MRI analysis showed that HCV-MC patients had a higher mean number of total (7.03 ± 9.9 vs 0.90 ± 1.81 and 2.03 ± 3.1; p <0.05) and periventricular (2.4 ± 3.0 vs 0.38 ± 0.5 and 0.8 ± 1.4; p <0.05) white matter high intensity signals than HCV controls and healthy controls, respectively. Conclusion. The high frequency of impaired cognitive function and the extent of MRI brain abnormalities in patients with HCV-associated mixed cryoglobulinemia vasculitis strongly suggest specific inflammatory involvement of the CNS.

AB - Objective. Involvement of the central nervous system (CNS) in patients with hepatitis C virus (HCV) mixed cryoglobulinemia (MC) is rare. The mechanism by which brain lesions are produced is unclear. We investigated these phenomena by clinical evaluation (neuropsychological tests) and cerebral magnetic resonance imaging (MRI) studies in patients with HCV-MC vasculitis. Methods. This prospective study included 40 patients with MC vasculitis and chronic active HCV infection (HCV RNA+), 11 HCV controls without MC, and 36 healthy controls, matched for sex and age. A battery of 10 standardized neuropsychological tests was administered by one experienced neuropsychiatrist. All patients underwent cerebral MRI investigation. Results. Twenty-four of the 27 (89%) evaluated patients with HCV-MC had a deficiency in one or more of the 10 cognitive domains examined. The most commonly involved domains were those of attention (70%), executive functions (44%), visual construction (37%), and visual spatial functions (33%). The number of impaired cognitive functions was significantly higher in patients with MC vasculitis than in HCV controls (2.18 ± 1.84 vs 0.87 ± 3.1; p <0.05). MRI analysis showed that HCV-MC patients had a higher mean number of total (7.03 ± 9.9 vs 0.90 ± 1.81 and 2.03 ± 3.1; p <0.05) and periventricular (2.4 ± 3.0 vs 0.38 ± 0.5 and 0.8 ± 1.4; p <0.05) white matter high intensity signals than HCV controls and healthy controls, respectively. Conclusion. The high frequency of impaired cognitive function and the extent of MRI brain abnormalities in patients with HCV-associated mixed cryoglobulinemia vasculitis strongly suggest specific inflammatory involvement of the CNS.

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