The varicella zoster virus vasculopathies: Clinical, CSF, imaging, and virologic features
| Autor: | Joseph Safdieh, M. De Martino, C. Terborg, Maria A. Nagel, Randall J. Cohrs, Ravi Mahalingam, W. D. Brown, C. J. Gardner, Mary Wellish, Michael J. Levy, Benjamin Greenberg, Bagher Forghani, E. Kamenkovich, Takeshi Saraya, A. Schiller, M. Ueno, Lyle W. Ostrow, Roland Nau, Martin Häusler, H. Wada, H. Goto, Donald H. Gilden, Andrew Russman, Irene L. Katzan |
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| Rok vydání: | 2008 |
| Předmět: |
Herpesvirus 3
Human Pathology medicine.medical_specialty viruses medicine.disease_cause Herpes Zoster Article Herpesviridae Virus 03 medical and health sciences Chickenpox 0302 clinical medicine Cerebrospinal fluid CSF pleocytosis medicine Humans 030212 general & internal medicine Stroke integumentary system business.industry Varicella zoster virus virus diseases Exanthema medicine.disease Magnetic Resonance Imaging Rash 3. Good health Cerebrovascular Disorders Immunology Neurology (clinical) medicine.symptom Vasculitis business 030217 neurology & neurosurgery |
| Zdroj: | Neurology. 70:853-860 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/01.wnl.0000304747.38502.e8 |
| Popis: | Background: Varicella zoster virus (VZV) vasculopathy produces stroke secondary to viral infection of cerebral arteries. Not all patients have rash before cerebral ischemia or stroke. Furthermore, other vasculitides produce similar clinical features and comparable imaging, angiographic, and CSF abnormalities. Methods: We review our 23 published cases and 7 unpublished cases of VZV vasculopathy. All CSFs were tested for VZV DNA by PCR and anti-VZV IgG antibody and were positive for either or both. Results: Among 30 patients, rash occurred in 19 (63%), CSF pleocytosis in 20 (67%), and imaging abnormalities in 29 (97%). Angiography in 23 patients revealed abnormalities in 16 (70%). Large and small arteries were involved in 15 (50%), small arteries in 11 (37%), and large arteries in only 4 (13%) of 30 patients. Average time from rash to neurologic symptoms and signs was 4.1 months, and from neurologic symptoms and signs to CSF virologic analysis was 4.2 months. CSF of 9 (30%) patients contained VZV DNA while 28 (93%) had anti-VZV IgG antibody in CSF; in each of these patients, reduced serum/CSF ratio of VZV IgG confirmed intrathecal synthesis. Conclusions: Rash or CSF pleocytosis is not required to diagnose varicella zoster virus (VZV) vasculopathy, whereas MRI/CT abnormalities are seen in almost all patients. Most patients had mixed large and small artery involvement. Detection of anti-VZV IgG antibody in CSF was a more sensitive indicator of VZV vasculopathy than detection of VZV DNA ( p GLOSSARY: EIA = enzyme immunoabsorbent assay; VZV = varicella zoster virus. |
| Databáze: | OpenAIRE |
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