Takao Hoshino1, Sono Toi2, Kunio Toda3, Yumiko Uchiyama4, Hiroshi Yoshizawa5, Mutsumi Iijima6, Yuko Shimizu7, Kazuo Kitagawa8. 1. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. Electronic address: hoshino.takao@twmu.ac.jp. 2. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. Electronic address: toi.sono@twmu.ac.jp. 3. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. Electronic address: joykunio@yahoo.co.jp. 4. Department of Neurology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan. Electronic address: yyyy@nij.twmu.ac.jp. 5. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. Electronic address: hyoshizaw@nij.twmu.ac.jp. 6. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. Electronic address: iijima.mutsumi@twmu.ac.jp. 7. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. Electronic address: yshimizu@nij.twmu.ac.jp. 8. Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan. Electronic address: kitagawa.kazuo@twmu.ac.jp.
Abstract
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.
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.
Authors: Inês Mollet; João Pedro Marto; Marcelo Mendonça; Miguel Viana Baptista; Helena L A Vieira Journal: Mol Neurobiol Date: 2021-10-22 Impact factor: 5.682
Authors: Marta Bertamino; Sara Signa; Marco Veneruso; Giulia Prato; Roberta Caorsi; Giuseppe Losurdo; Federica Teutonico; Silvia Esposito; Francesca Formica; Nicola Tovaglieri; Maria A Nagel; Giulia Amico; Alice Zanetti; Domenico Tortora; Andrea Rossi; Paolo Moretti; Marco Gattorno; Angelo Ravelli; Mariasavina Severino Journal: J Neurol Date: 2021-05-27 Impact factor: 6.682