2023 Volume 45 Issue 6 Pages 486-492
A 60-year-old man was admitted to our hospital for 12 days with acute cerebral infarction due to occlusion of the right anterior cerebral artery A2 approximately two months previously. He presented with mild right hemiparesis and executive dysfunction at work, and was readmitted for acute cerebral infarction due to occlusion of the left proximal middle cerebral artery (MCA) M1. High-resolution magnetic resonance vessel wall imaging (VWI) revealed concentric wall thickening at the site of occlusion of the left proximal MCA M1. A sample of his cerebrospinal fluid was subjected to a FilmArray Meningitis/Encephalitis panel for the diagnosis of central nervous system vasculitis, and varicella-zoster virus (VZV) nucleic acid was detected. Although no preceding rash was observed, VZV vasculopathy was suspected, and the patient was treated with intravenous acyclovir and oral prednisolone. His symptoms improved after treatment. Contrast-enhanced magnetic resonance VWI revealed wall thickening and enhancement at the site of occlusion of the left proximal MCA M1. Follow-up VWI nine weeks after the treatment revealed decreased wall thickening and enhancement. Furthermore, follow-up magnetic resonance angiography three and a half months after the treatment revealed recanalization of the left proximal MCA M1. The FilmArray Meningitis/Encephalitis panel was useful for earlier diagnosis, and VWI findings were also useful for diagnosis and prognosis prediction.
