Subarachnoid Hemorrhage, CNS Vasculitis and Stroke as a Sequela of Q Fever Infection.

IF 0.7 Q4 CLINICAL NEUROLOGY
Melinda C Arthur, Christopher S Medina, Erin Penn, Hector Ojeda-Martinez, Elie Dancour, Paul Wright
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Abstract

A 64-year-old female with a history of Subarachnoid Hemorrhage (SAH) of non-aneurysmal origin underwent 4 cerebral Digital Subtraction Angiography (cDSA) studies to investigate the cause of the SAH. All angiograms were unrevealing. Two years and 3 months following her SAH, she presented to the emergency department with ataxia and aphasia. Magnetic Resonance Imaging (MRI) of the brain without contrast showed a right posterior parietal lobe stroke with a watershed appearance and a chronic right cerebellar infarct with encephalomalacia. Repeat cDSA showed stenosis in the right A3 of the Anterior Cerebral Artery (ACA) and right M2 of the Middle Cerebral Artery (MCA) suggesting CNS vasculitis. Known reversible and secondary causes of CNS vasculitis were tested and found to be negative. However, Indirect Immunofluorescence Assay (IFA) testing revealed a high titer of IgG phase II Coxiella indicating acute Q fever. CDC lab findings from 10 years earlier also showed a high titer IgG phase II Coxiella, indicating untreated Q fever prior to the SAH event. A whole-body Positron Emission Tomography (PET) scan was negative for systemic or CNS vasculitis. The patient was treated for Q fever and CNS vasculitis with 1 year of doxycycline and hydroxychloroquine. There was no recurrence of symptoms 15 months after treatment. We conclude that Q fever can present with SAH in addition to CNS vasculitis and stroke.

Q热感染的后遗症:蛛网膜下腔出血、中枢神经系统血管炎和中风。
一名64岁女性,有非动脉瘤性蛛网膜下腔出血(SAH)病史,通过4次脑数字减影血管造影(cDSA)研究SAH的病因。所有的血管造影都没有显示。SAH发生2年零3个月后,她以共济失调和失语就诊于急诊科。脑磁共振成像(MRI)无对比显示右脑后顶叶卒中伴分水岭外观和慢性右脑梗死伴脑软化。重复cDSA示右侧大脑前动脉A3和右侧大脑中动脉M2狭窄,提示中枢神经系统血管炎。已知的可逆和继发性中枢神经系统血管炎的原因进行了测试,发现是阴性的。然而,间接免疫荧光检测(IFA)显示高滴度的IgG II期Coxiella提示急性Q热。美国疾病控制与预防中心10年前的实验室结果也显示出高滴度的IgG II期克希氏菌,表明在SAH事件之前未经治疗的Q热。全身正电子发射断层扫描(PET)未发现系统性或中枢神经系统血管炎。患者因Q热和中枢神经系统血管炎给予强力西环素和羟氯喹治疗1年。治疗后15个月无症状复发。我们得出结论,除了中枢神经系统血管炎和中风外,Q热还可能出现SAH。
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来源期刊
Neurohospitalist
Neurohospitalist CLINICAL NEUROLOGY-
CiteScore
1.60
自引率
0.00%
发文量
108
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