Ischemic Stroke due to Virologically-Confirmed Varicella Zoster Virus Vasculopathy: A Case Series.
BACKGROUND
Limited data are available regarding the characteristics and prognosis of patients with stroke due to varicella zoster virus (VZV) vasculopathy.


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
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
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.
['Hoshino|Takao|T|', 'Toi|Sono|S|', 'Toda|Kunio|K|', 'Uchiyama|Yumiko|Y|', 'Yoshizawa|Hiroshi|H|', 'Iijima|Mutsumi|M|', 'Shimizu|Yuko|Y|', 'Kitagawa|Kazuo|K|']
D000212:Acyclovir D000328:Adult D000998:Antiviral Agents D002545:Brain Ischemia D003389:Cranial Nerve Diseases D038524:Diffusion Magnetic Resonance Imaging D005260:Female D005343:Fibrinolytic Agents D014645:Herpesvirus 3, Human D006801:Humans D018810:Magnetic Resonance Angiography D008297:Male D008875:Middle Aged D012189:Retrospective Studies D013256:Steroids D020521:Stroke D016896:Treatment Outcome D000073618:Varicella Zoster Virus Infection
ischemic stroke vasculopathy cranial nerve Antithrombotic therapy varicella-zoster virus