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Abstract
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.
- stroke
- herpes zoster
- clinical neurology
- cerebrovascular
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Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.
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Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.
Footnotes
X @AriBarreau
Contributors AB and JL contributed equally to the writing of this manuscript and edits. BW identified the relevant imaging findings and reviewed the image descriptions. FM supervised and edited the paper and is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally reviewed by Martin Sadler, Plymouth, UK.