Ischemic Stroke due to Virologically-Confirmed Varicella Zoster Virus Vasculopathy: A Case Series.
Acyclovir
/ therapeutic use
Adult
Antiviral Agents
/ therapeutic use
Brain Ischemia
/ diagnostic imaging
Cranial Nerve Diseases
/ virology
Diffusion Magnetic Resonance Imaging
Female
Fibrinolytic Agents
/ therapeutic use
Herpesvirus 3, Human
/ drug effects
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Retrospective Studies
Steroids
/ therapeutic use
Stroke
/ diagnostic imaging
Treatment Outcome
Varicella Zoster Virus Infection
/ complications
Antithrombotic therapy
cranial nerve
ischemic stroke
varicella-zoster virus
vasculopathy
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
28
07
2018
revised:
26
09
2018
accepted:
01
10
2018
pubmed:
6
11
2018
medline:
29
1
2019
entrez:
6
11
2018
Statut:
ppublish
Résumé
Limited data are available regarding the characteristics and prognosis of patients with stroke due to varicella zoster virus (VZV) vasculopathy. We studied 4 patients (2 men and 2 women; age, 38-63 years) from a single center who developed acute ischemic stroke due to VZV vasculopathy. The virological diagnosis was confirmed by detecting VZV DNA and/or the IgG antibody to VZV in the cerebrospinal fluid. Three patients were taking immunosuppressive agents, including prednisolone and/or methotrexate, at baseline. Each patient had a characteristic skin rash prior to stroke, with the interval from rash to stroke onset ranging from 13 to 122 days. Two patients experienced antecedent cranial nerve palsies; one had the third, seventh, ninth, and 10th nerve palsies and the other had the fourth nerve palsy before stroke. Cerebral infarctions were located in the anterior circulation lesion (n = 1), in the posterior circulation lesion (n = 2), and in both lesions (n = 1). Intracranial arterial stenosis was only identified in one patient on magnetic resonance angiography. A high plasma d-dimer level was detected in 1 patient, whereas high β-thromboglobulin and platelet factor 4 levels were detected in 2 patients. As a result of combined therapies with acyclovir, steroid, and antithrombotic agents, neurological symptoms markedly improved in 3 patients, whereas 1 patient was left with moderate hemiplegia. Cranial nerve palsies may be prodromal symptoms of VZV-associated stroke. Increased levels of thrombotic markers may support the use of antithrombotic agents, although the benefit of combined treatment should be determined through larger studies.
Sections du résumé
BACKGROUND
BACKGROUND
Limited data are available regarding the characteristics and prognosis of patients with stroke due to varicella zoster virus (VZV) vasculopathy.
METHODS
METHODS
We studied 4 patients (2 men and 2 women; age, 38-63 years) from a single center who developed acute ischemic stroke due to VZV vasculopathy. The virological diagnosis was confirmed by detecting VZV DNA and/or the IgG antibody to VZV in the cerebrospinal fluid.
RESULTS
RESULTS
Three patients were taking immunosuppressive agents, including prednisolone and/or methotrexate, at baseline. Each patient had a characteristic skin rash prior to stroke, with the interval from rash to stroke onset ranging from 13 to 122 days. Two patients experienced antecedent cranial nerve palsies; one had the third, seventh, ninth, and 10th nerve palsies and the other had the fourth nerve palsy before stroke. Cerebral infarctions were located in the anterior circulation lesion (n = 1), in the posterior circulation lesion (n = 2), and in both lesions (n = 1). Intracranial arterial stenosis was only identified in one patient on magnetic resonance angiography. A high plasma d-dimer level was detected in 1 patient, whereas high β-thromboglobulin and platelet factor 4 levels were detected in 2 patients. As a result of combined therapies with acyclovir, steroid, and antithrombotic agents, neurological symptoms markedly improved in 3 patients, whereas 1 patient was left with moderate hemiplegia.
CONCLUSIONS
CONCLUSIONS
Cranial nerve palsies may be prodromal symptoms of VZV-associated stroke. Increased levels of thrombotic markers may support the use of antithrombotic agents, although the benefit of combined treatment should be determined through larger studies.
Identifiants
pubmed: 30392831
pii: S1052-3057(18)30580-9
doi: 10.1016/j.jstrokecerebrovasdis.2018.10.001
pii:
doi:
Substances chimiques
Antiviral Agents
0
Fibrinolytic Agents
0
Steroids
0
Acyclovir
X4HES1O11F
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
338-343Informations de copyright
Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.