1043-3155 Pediatr Neurol Briefs pedneurbriefs Pediatr Neurol Briefs Pediatric Neurology Briefs Pediatr Neurol Briefs 2166-6482 1043-3155 2166-3155 Pediatric Neurology Briefs Publishers Chicago, IL, USA PNB-22-23-b 10.15844/pedneurbriefs-22-3-10 Infectious Disorders Neurology Pediatrics Nervous System Diseases Child Development Brain Diseases Neurosurgery Child Infant Varicella Zoster Virus Vasculopathies http://orcid.org/0000-0002-0173-7931 Millichap J. Gordon MD 1 2 * Division of Neurology, Children's Memorial Hospital, Chicago, IL Departments of Pediatrics and Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Correspondence: Dr. J. Gordon Millichap, E-mail: jgmillichap@northwestern.edu 03 2008 01 02 2016 22 3 23 24 Copyright: © 2008 The Author(s) 2008 This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The varicella zoster virus vasculopathies. Clinical, CSF, imaging, and virologic features

The clinical, CSF, imaging, and virological features of varicella zoster virus (VZV) vasculopathies in 30 patients (7 children) are reviewed by researchers at various centers in the US and internationally.

 Varicella Zoster Virus Focal Vascular Abnormalities CSF Pleocytosis

The clinical, CSF, imaging, and virological features of varicella zoster virus (VZV) vasculopathies in 30 patients (7 children) are reviewed by researchers at various centers in the US and internationally. The data obtained on the 7 children, ages 1-7 and 18, show rash in 5, CSF pleocytosis in 6, focal lesions on MRI/CT in 7, focal vascular abnormalities by angiography or MRA in 3 of 4 tested, small vessel involvement in 2 and mixed in 5, CSF VZV DNA in 2, and IgG in 5, and reduced serum/CSF ratio of VZV IgG in 5, confirmation of intrathecal synthesis. Average time from rash to neurologic symptoms and signs and virologic analysis was 4.1 months. In children it varied from 1-2 days to 3 months. Detection of anti-VZV IgG antibody in CSF is a more sensitive indicator of VZV vasculopathy than VZV DNA (p < 0.001). Of 15 patients (13 adults and 2 children) treated with IV acyclovir alone for 10-28 days, 66% improved or stabilized compared to 75% of 12 patients (9 adults and 3 children) who received both IV acyclovir and steroids. Of 2 children not treated, 1 stabilized and the other improved slowly. [1]

COMMENT. VZV is a possible cause of stroke in children and adults, even without a history of rash. Prior rash was absent in 29% of children and in 40% of the total group. Symptoms of vasculopathy can be delayed up to 3 months after the rash in children, 4 months in adults. CSF pleocytosis was present in the majority (86%) of children, but absent in 33% of the total group.

Acute infection, viral or bacterial, is a risk factor for cerebral infarction and stroke in all age groups. The reported prevalence of infection in the week preceding ischemic stroke ranges from 10% to 35%. Influenza vaccination has been correlated with a lower risk of stroke. [2]

Herpes zoster live-attenuated vaccine in elderly subjects was effective and increased VZV-T cell-mediated immunity within 6 weeks after vaccination. Boosting immunity by vaccination should protect older adults against herpes zoster and postherpetic neuralgia, at least 4 years or longer. [3]

Nagel MA Cohrs RJ Mahalingam R Wellish MC Forghani B Schiller A The varicella zoster virus vasculopathies. Clinical, CSF, imaging, and virologic features Neurology 2008 March 11 70 11 853 860 10.1212/01.wnl.0000304747.38502.e8 18332343 Emsley HCA Hopkins SJ Acute ischaemic stroke and infection: recent and emerging concepts Lancet Neurology 2008 April 7 4 341 353 10.1016/S1474-4422(08)70061-9 18339349 Levin MJ Oxman MN Zhang JH Johnson GR Stanley H Hayward AR Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine J Infect Dis 2008 March 15 197 6 825 835 10.1086/528696 18419349