Role of Varicella-Zoster Virus in Pediatric Stroke Syndromes

Abstract

Infectious Diseases| October 01 2000 Role of Varicella-Zoster Virus in Pediatric Stroke Syndromes AAP Grand Rounds (2000) 4 (4): 34–35. https://doi.org/10.1542/gr.4-4-34-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Role of Varicella-Zoster Virus in Pediatric Stroke Syndromes. AAP Grand Rounds October 2000; 4 (4): 34–35. https://doi.org/10.1542/gr.4-4-34-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cerebrovascular accident in children, human herpesvirus 3 Sources: (1) Moriuchi H, Rodriguez W. Role of varicella-zoster virus in stroke syndromes. Pediatr Infect Dis J. 2000;19:648–653. (2) Berger TM, Caduff JH, Gebbers JO. Fatal varicella-zoster virus antigen-positive giant cell arteritis of the central nervous system. Pediatr Infect Dis J. 2000;19:653–656. Moriuchi and Rodriguez report the case of a previously healthy 12-year-old girl who developed acute right facial weakness and left hemiparesis and was admitted to the Children’s National Medical Center, Washington, DC. MRI of her brain on admission showed edema within the right putamen and right caudate and a beaded irregularity of the first segment of the right middle cerebral artery. Gradual improvement in motor function occurred without therapy, until no neurologic deficit remained. Her past history was unremarkable except for an episode of right herpes zoster ophthalmicus 9 months earlier. Primary varicella occurred at 9 months. The clinical diagnosis of a herpes zoster related vasculitis of the right middle cerebral artery was confirmed when polymerase chain reaction (PCR) for VZV-specific DNA in CSF was positive. A review of the literature yielded 28 cases of stroke associated with varicella, almost always in normal children aged 8 months to 16 years, who developed hemiplegia or other stroke manifestation a few weeks or months after primary varicella (median interval 2 months) and who had basal ganglia and/or capsular infarct(s) due to vasculopathy of the middle cerebral artery. The neurologic outcome without treatment has been generally good. In the above patient a related entity occurred, stroke syndrome associated with contralateral herpes zoster ophthalmicus. This is usually seen in adults, but 5 children (all immunocompetent) have been reported with an interval of 4 weeks to 9 months between the herpes zoster ophthalmicus and stroke; recovery had been complete in only some of these patients. In the companion article, Berger et al report a case from Lucerne, Switzerland, of a previously healthy 4-year-old girl with an acute right hemiparesis and aphasia who had had a similar episode lasting several hours seven months earlier, and another 15-minute episode one week earlier. Imaging studies confirmed a left middle cerebral artery infarct, and the child died within 48 hours of presentation. Autopsy revealed a left cerebral infarct and an active giant cell granulomatous arteritis involving the wall of the left middle cerebral artery, with occlusion by fresh thrombus. Immunohistochemical staining for varicella zoster virus was positive in the smooth muscle of the vessel wall. This child had acute varicella 13 months earlier. These reports, in addition to over 30 prior ones demonstrate that varicella infection plays a substantial role in pediatric ischemic stroke syndromes1,2 and highlight the value of molecular-based diagnostic techniques. PCR detected the presence of specific DNA in the CSF of Moriuchi’s patient by repeated amplification cycles to expand the number of molecules present in CSF to a number that could be detected. Stroke has not been reported following varicella vaccine and it seems quite likely that immunization with the highly attenuated... You do not currently have access to this content.