Abstract
We describe a case of delayed stroke due to varicella-zoster virus (VZV) vasculopathy caused by herpes zoster ophthalmicus 4 months prior. A healthy 30-year-old man with acute left hemiplegia and impaired consciousness was admitted to our hospital. Magnetic resonance imaging showed multiple acute ischemic strokes in the right cerebrum and basal ganglia, and contrast-enhanced magnetic resonance angiography revealed occlusion of the right middle cerebral arteries (MCA) at the stem and thickening of the vessel wall with enhancement of the MCA, suggesting vasculitis. Four months earlier, the patient had herpes zoster infection in the first branch of the right trigeminal nerve area. Although cerebrospinal fluid (CSF) VZV DNA presence was negative, CSF VZV IgG was positive. Therefore, ischemic stroke due to VZV vasculopathy was diagnosed, and the patient was treated with acyclovir and steroids. Thereafter, there was no progression of ischemic stroke, and the right MCA occlusion subsequently improved.
If a patient with ischemic stroke has a recent history of herpes zoster, poor cardiovascular risk factors, recurrent cases, imaging findings atypical for atherosclerosis, immunocompromised patients, chronic headache, altered mental status, or fever, VZV vasculopathy should be suspected and CSF VZV IgG should be examined for diagnosis.
