Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Cerebral infarction related to varicella zoster virus vasculopathy

Satoshi Namitome, M.D.1), Seigo Shindo, M.D.1), Kuniyasu Wada, M.D.1), Tadashi Terasaki, M.D.1), Makoto Nakajima, M.D., Ph.D.2) and Yukio Ando, M.D., Ph.D.2)

1)Department of Neurology, Kumamoto Red Cross Hospital
2)Department of Neurology, Graduate School of Medical Sciences, Kumamoto University

A 14-year-old girl developed transient disturbance of consciousness, dysarthria, and clumsiness of the right upper limb 4 months after herpes zoster ophthalmicus. Brain MRI showed acute cerebral infarction in the left middle cerebral artery (MCA) territory. CT angiography demonstrated mild stenosis in the top of the left internal carotid artery and the proximal side of the MCA. Cerebrospinal fluid (CSF) examination showed slightly mononuclear pleocytosis (6/µl). Titer of the anti-varicella zoster virus (VZV) IgG antibodies in CSF was increased, and gadolinium-enhanced brain MRI (T1-weighted imaging) revealed enhancement of the vessel walls at the stenotic lesions. Based on the diagnosis of VZV vasculopathy, methylprednisolone and valacicrovir were administered, followed by acyclovir, in addition to antithrombotic therapy using aspirin and warfarin. After these treatment, her right upper clumsiness was resolved and gadoliniumenhancement of the vessel walls was disappeared on MRI. VZV vasculopathy may cause ischemic stroke in young patients, especially in children. A careful history-taking about herpes is necessary to detect the disease as a potential cause in young stroke patients.
Full Text of this Article in Japanese PDF (2572K)

(CLINICA NEUROL, 58: 182|187, 2018)
key words: young stroke, varicella zoster virus, antibody index, enhanced brain MRI

(Received: 2-Nov-17)