Neurologic complications of hepatitis C

BACKGROUND: Hepatitis C virus (HCV) infection is a common and chronic disorder with numerous extrahepatic manifestations. We review the neurologic complications in this article. REVIEW SUMMARY: Neurologic complications can involve the peripheral or the central nervous system. The most frequently reported complication is a subacute, distal, symmetric, sensorimotor polyneuropathy in the presence of mixed cryoglobulinemia (MC). HCV infection is the most common cause of MC. In HCV-infected patients without MC, mononeuropathy or mononeuropathy multiplex is more common. Both ischemic and hemorrhagic strokes, probably related to MC and vasculitis, have been described. More recently, transverse myelopathy and cognitive impairment have been linked to HCV infection, but the association is less certain and needs to be confirmed in larger studies. HCV has also been reported as a possible cause of encephalomyelitis in some cases. Although there are no definite treatment guidelines, immunomodulating agents and antiviral therapy are most often used with favorable outcomes. CONCLUSIONS: HCV infection should be considered in the differential diagnosis of a variety of neurologic disorders. Further studies are necessary to establish the full spectrum of the neurologic complications, identify specific pathophysiologic mechanisms, and provide clear guidelines for management.