Varicella-zoster Vasculopathy Research Articles

Varicella zoster vasculopathy causing recurrent ischaemic strokes in an immunocompetent patient.

A 66-year-old woman reported 10 days of generalised weakness, falls and memory 'glitches'. She had developed left-sided ophthalmic herpes zoster 3 months before but was otherwise well. MR scan of brain showed acute left-sided ischaemic strokes and CT cerebral angiogram identified marked stenoses of the left anterior and middle cerebral arteries. We suspected varicella-zoster virus vasculopathy, confirmed by cerebrospinal fluid analysis. Initially she had further ischaemic strokes despite intravenous acyclovir, prednisone, aspirin and clopidogrel. However, after prolonged acyclovir and prednisone, there were no new infarcts though imaging of left anterior and middle cerebral artery vessel walls showed persistent inflammation. Varicella zoster vasculopathy can cause recurrent ischaemic strokes, even in immunocompetent people with no cardiovascular risk factors, and despite long-term antiviral therapy.

Varicella Zoster Vasculopathy Presenting as Eight and a Half Syndrome

Varicella Zoster Vasculopathy Presenting as Eight and a Half Syndrome

Varicella Zoster Vasculopathy Exacerbated by Tofacitinib in a Patient With Ulcerative Colitis

HomeStrokeAhead of PrintVaricella Zoster Vasculopathy Exacerbated by Tofacitinib in a Patient With Ulcerative Colitis No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessVaricella Zoster Vasculopathy Exacerbated by Tofacitinib in a Patient With Ulcerative Colitis Kyle A. Lyman, Anirudh Sreekrishnan, Prateek Thatikunta, Ryan McConnell, Maarten G. Lansberg and Christina M. Mijalski Sells Kyle A. LymanKyle A. Lyman https://orcid.org/0000-0002-3309-7211 Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (K.A.L., A.S., P.T., M.G.L., C.M.M.S.). Search for more papers by this author , Anirudh SreekrishnanAnirudh Sreekrishnan https://orcid.org/0000-0001-7251-7189 Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (K.A.L., A.S., P.T., M.G.L., C.M.M.S.). Search for more papers by this author , Prateek ThatikuntaPrateek Thatikunta https://orcid.org/0000-0001-6542-2827 Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (K.A.L., A.S., P.T., M.G.L., C.M.M.S.). Search for more papers by this author , Ryan McConnellRyan McConnell Department of Gastroenterology, Palo Alto Medical Foundation, CA (R.M.). Search for more papers by this author , Maarten G. LansbergMaarten G. Lansberg https://orcid.org/0000-0002-3545-6927 Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (K.A.L., A.S., P.T., M.G.L., C.M.M.S.). Search for more papers by this author and Christina M. Mijalski SellsChristina M. Mijalski Sells Correspondence to: Christina M. Mijalski Sells, MD, MPH, Department of Neurology and Neurological Sciences, Center for Academic Medicine, 453 Quarry Rd, Stanford, CA 94305. Email E-mail Address: [email protected] Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (K.A.L., A.S., P.T., M.G.L., C.M.M.S.). Search for more papers by this author Originally published6 Apr 2023https://doi.org/10.1161/STROKEAHA.122.042228Stroke. 2023;0FootnotesFor Sources of Funding and Disclosures, see page XXX.Correspondence to: Christina M. Mijalski Sells, MD, MPH, Department of Neurology and Neurological Sciences, Center for Academic Medicine, 453 Quarry Rd, Stanford, CA 94305. Email [email protected]edu Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.042228PMID: 37021571 Originally publishedApril 6, 2023 Keywordsseizureshumansherpes zosterprednisoneagedbrainPDF download Advertisement SubjectsCerebrovascular Disease/StrokeIschemic StrokeMagnetic Resonance Imaging (MRI)

Central nervous system varicella zoster vasculopathy in an immunocompromised patient.

Central nervous system (CNS) vasculopathy associated with Varicella Zoster Virus (VZV) infection, usually manifesting as stroke due to ischemic lesions by involvement of small arteries, is frequently misdiagnosed. Immunocompromised patients have a particularly higher risk of severe disease and also CNS involvement during or following VZV presentations. We report a case of an 84-year-old man, with myelodysplastic syndrome, who presented with herpes zoster ophthalmicus complicated with left periocular cellulitis and an abnormal neurological exam. Intravenous treatment with acyclovir and amoxicillin/clavulanic acid was began. VZV DNA was detected in the cerebrospinal fluid (CSF) and brain magnetic resonance imaging revealed three acute ischemic lesions in the left frontal and both cerebellar lobes. A VZV CNS multifocal vasculopathy was diagnosed and treatment with intravenous acyclovir continued for 21 days.Immunocompromised patients with VZV infection can have a more severe course of disease with disseminated involvement and multifocal vasculopathy. In these patients the CSF detection of anti-VZV IgG as well as VZV DNA can be helpful in the diagnosis of CNS VZV vasculopathy. The antiviral treatment can improve the outcome and should be adjusted taking in consideration the degree of immunosuppression. This clinical case and review of the literature highlights the challenges in the diagnosis and management of VZV CNS vasculopathy in immunocompromised patients.

Clinical interpretation of high-resolution vessel wall MRI of intracranial arterial diseases.

Intracranial arterial pathology has traditionally been evaluated with luminal imaging. Recently, high-resolution vessel wall imaging (HR-VWI) with MRI has facilitated submillimetre evaluation of the arterial walls. This technique can help differentiate various causes of intracranial steno-occlusive disease, identify culprit atherosclerotic plaques with a recent cerebral infarct, locate vessel wall pathology in areas with minimal or no narrowing on luminal imaging, predict aneurysm stability and identify a ruptured aneurysm when multiple aneurysms are present. Interpretation of HR-VWI examinations requires a solid understanding of the pathophysiology, clinical features, serum and cerebrospinal fluid laboratory findings, treatment administered and fundamental patterns of VWI abnormalities that may be encountered with the intracranial vasculopathies. This pictorial essay aimed to illustrate the essential findings of common conditions encountered with HR-VWI including intracranial atherosclerosis, moyamoya disease, intracranial vasculitis, varicella zoster vasculopathy, reversible cerebral vasoconstriction syndrome and aneurysms.

Arterial ischemic stroke in HIV: Defining and classifying etiology for research studies.

HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Multiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the terminology used, a robust classification algorithm to help ascribe the various etiologies is needed. This consensus paper considers the strengths and limitations of current case definitions in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some instances new case definitions were described (e.g., HIV-associated vasculopathy). These case definitions provided a framework for an algorithm to help assign a final diagnosis, and help classify the subtypes of HIV etiology in ischemic stroke.

Abstract TP225: The Central Nervous System Varicella Zoster Virus (CNS-VZV) Vasculopathy in HIV Patients

Background: Varicella zoster vasculopathy of the central nervous system (CNS-VZV) is rare. This topic has not been systemically analyzed in HIV patients. Method: We reviewed case reports/series in the literature from Pubmed using search term: varicella zoster, vasculopathy, stroke and HIV. Results: Forty-eight patients were identified. Eight patients (17%) had VZV vasculopathy after started on highly active antiretroviral therapy (HAART) consistent with central nervous system immune reconstitution inflammatory syndrome (CNS-IRIS). The average time from starting HAART to a neurological deficit was approximately 3 weeks. Rash occurred in ∼67%, with a mean 12 month interval from rash to CNS symptom onset though in 18 (64%) it occurred just prior to symptom onset. Patients had CNS lesions in the following distributions: posterior circulation, n=22 (46%); anterior circulation, n=13 (27%); and spinal, n=10 (21%). Specific abnormalities included stenosis/occlusion in 15 (83%), saccular aneurysm in 4 (22%), fusiform aneurysm in 2 (18%), and arterial wall enhancement in 2 (11%). The vasculopathy involved large vessels in 21/47 patients (45%), small arteries in 19 (40%), and both large and small arteries in 7 (15%). CSF pleocytosis was found in 30/36 patients (83%) (mean: 101), and CSF protein was elevated in 25/34 patients (74%). CSF immunological analysis was available in 29 patients. Twenty-five patient (89%) had either CSF positive for VZV DNA by PCR or anti-VZV IgG. 17/23 (74%) patients had VZV DNA positive in their CSF, and 13/21 (62%) had anti-VZV IgG antibody. Of the 35 patients with available treatment data, acyclovir was used as initial treatment in 27 (77%) with good recovery in 23 (85%). Thirteen cases received acyclovir with corticosteroids, and 11 had a good recovery (84%). Fourteen cases received acyclovir alone; 8 had a good recovery (57%). The mortality rate was 49%. VZV vasculopathy secondary from CNS-IRIS had better prognosis with a mortality rate 13%. Conclusion: Prompt treatment with acyclovir while waiting for CSF immunology is critical when CNS-VZV vasculopathy is a possibility. Rash, abnormal angiography or CSF pleocytosis give clues for diagnosis but not rule it out if negative. Steroid seems to improve the outcome of these patients.

Acute Retinal Necrosis in the Setting of Varicella Zoster Vasculopathy - Case Report & Review of Literature (P5.301)

Acute Retinal Necrosis in the Setting of Varicella Zoster Vasculopathy - Case Report & Review of Literature (P5.301)

Varicella-Zoster Virus Vasculopathy: A Case Report Demonstrating Vasculitis using Black-Blood MRI.

Infections are rare but important causes of stroke. Among these, varicella zoster virus has been known to cause ischemic stroke. During an attack of herpes zoster ophthalmicus, it has been hypothesized that the virus replicates in the trigeminal ganglion and travels via the trigeminal nerve centrally to cause cerebral vasculopathy. Here we present a case of a 69 year-old Caucasian immunocompromised woman who suffered recurrent ischemic infarcts within the same vascular distribution following an episode of zoster ophthalmicus three months prior. An imaging technique termed black-blood magnetic resonance imaging was utilized to aid in the diagnosis of cerebral vasculitis. The case is used to provide a literature review of the pathogenesis, diagnosis, and treatment of cerebral varicella zoster vasculopathy. In situations where an isolated unilateral cerebral vasculopathy is identified, neurologists are urged to consider varicella zoster as a treatable etiologic agent, as untreated vasculopathy can lead to further strokes.

Nevin Stewart Scrimshaw, PhD, MD, MPH, 1918-2013

: HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Multiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the terminology used, a robust classification algorithm to help ascribe the various etiologies is needed. This consensus paper considers the strengths and limitations of current case definitions in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some instances new case definitions were described (e.g., HIV-associated vasculopathy). These case definitions provided a framework for an algorithm to help assign a final diagnosis, and help classify the subtypes of HIV etiology in ischemic stroke.

Ranolazine-Induced Severe Bladder Hypotonia; Fatal Varicella-Zoster Vasculopathy Associated with Adalimumab Therapy; SIADH Induced by a Single Dose of Cyclophosphamide; Tetany, Hypomagnesemia, and Proton Pump Inhibitors; Unnecessary Surgery for Acute Abdomen Caused by ACE Inhibitor Use; Atazanavir-Associated Renal Stones and Biliary Stones; Drug-Induced Hallucinations Associated with Amantadine and Tizanidine

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MEDWATCH program (800-FDA-1088).

Varicella zoster vasculopathy presenting as lateral medullary syndrome

Varicella zoster vasculopathy presenting as lateral medullary syndrome