SHM Converge Scientific Abstract ePoster Gallery-VZV Vasculopathy: A Hidden Cause of Stroke

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Varicella zoster virus (VZV) vasculopathy is an important cause of stroke-like illness that can occur after primary infection or, more commonly, after reactivation as herpes zoster. It should be considered in patients with a recent history of VZV infection who develop confusion, aphasia, focal neurologic deficits, or other signs of stroke. Risk is increased after herpes zoster ophthalmicus and in immunocompromised patients, but it can also occur in immunocompetent individuals.<br /><br />The case presented an 84-year-old man who developed worsening confusion and altered mental status three months after left herpes zoster ophthalmicus. Initial workup was unrevealing, but he later developed aphasia. Repeat imaging showed low attenuation in the basal ganglia, and MRI demonstrated multiple acute infarcts involving the left basal ganglia, corona radiata, cerebellum, and temporal lobe. Cerebrospinal fluid testing was positive for VZV PCR, and cerebral angiography showed intracranial vascular narrowing, confirming VZV vasculopathy.<br /><br />Typical presentation occurs up to four months after VZV infection and often resembles ischemic stroke. Imaging classically reveals multifocal acute cerebral infarcts. Diagnosis is supported by detection of VZV PCR or VZV IgG in cerebrospinal fluid.<br /><br />Treatment consists of intravenous acyclovir 10 mg/kg three times daily for three weeks, often combined with prednisone 1 mg/kg for five days. Early recognition is critical because prompt antiviral therapy may improve outcomes and prevent further ischemic injury.

Asset Subtitle

Cole J. White

Meta Tag

Author List Cole J. White

Category Clinical Vignettes

Concept Varicella-Zoster Virus Vasculopathy

Concept Stroke

Concept Cerebral Infarction

Concept CSF VZV PCR

Concept Viral Capsid Antigen IgG

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist Hospital Internal Medicine Residency Program

Presenting Author Cole J. White

Track Adult

Keywords

Varicella zoster virus

VZV vasculopathy

stroke-like illness

herpes zoster ophthalmicus

confusion

aphasia

multifocal cerebral infarcts

cerebrospinal fluid PCR

intravenous acyclovir

intracranial vascular narrowing

Varicella-Zoster Virus Vasculopathy

Stroke

Cerebral Infarction

CSF VZV PCR

Viral Capsid Antigen IgG