RESUMEN
itor Title: Varicella zoster virus reactivation antedating ipsilateral brainstem stroke Authors: Giuliana Galassi1, Maurilio Genovese2, Marisa Meacci3, Marcella Malagoli2 Affiliations: 1Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Italy, 2Neuroradiology Service, University Hospital of Modena, Italy, 3Department of Laboratory Medicine and Patholgy, Microbiology and Virology Unit, University Hospital of Modena, Italy Corresponding Author: Giuliana Galassi, MD, Department of Biomedical, Metabolic, Neural Sciences, University Hospital of Modena, Via P. Giardini 1455, Modena, Italy, Tel: 39-3497325802, Email: giulianagalassi46@gmail.com Abstract: Varicella zoster virus (VZV) infection and reactivation are associated with a number of neurologic conditions. Unifocal large vessel infarcts may follow zoster in the trigeminal or cervical distribution as a result of transaxonal transport of virus from trigeminal or cervical afferent fibers that innervate vessels. Ophthalmic zoster (HZO) might cause ophthalmoplegic syndromes, with secondary optic neuritis. Mechanisms include local orbital muscle inflammation and, viral spread from the ophthalmic branch of the fifth nerve with associated vasculopathy. A 72-year-old man developed a vesicular rash in the territory of C5-T5-6. Within four weeks, the patient developed headache, dysphagia, left facial and extremity ataxic weakness. Magnetic resonance imaging (MRI) revealed a right pontine infarction. A 66-year-old woman presented with right-sided painfull HZO. One week later she developed complete external ophthalmoplegia and blurred vision. MRI showed ill-defined signal alteration in the retrobulbar tissue. Three weeks later, the patient was admitted because of dysarthria, deviated tongue, left-sided limb weakness, and tactile hypoesthesia. Spinal fluid contained 23 lymphocytes/mm3 and increased protein. The serum contained antibodies to VZV IgG and IgM in both cases. The patients received intravenously acyclovir with improvement. This report confirms unusual occurrence of ipsilateral brainstem stroke after VZV reactivation in immunocompetent subjects.
Asunto(s)
Infartos del Tronco Encefálico/diagnóstico , Herpes Zóster Oftálmico/diagnóstico , Puente/diagnóstico por imagen , Enfermedades Vasculares/diagnóstico , Aciclovir/uso terapéutico , Anciano , Anticuerpos Antivirales/sangre , Antivirales/uso terapéutico , Infartos del Tronco Encefálico/etiología , Infartos del Tronco Encefálico/virología , Femenino , Herpes Zóster Oftálmico/sangre , Herpes Zóster Oftálmico/complicaciones , Herpes Zóster Oftálmico/tratamiento farmacológico , Herpesvirus Humano 3/inmunología , Humanos , Imagen por Resonancia Magnética , Masculino , Puente/irrigación sanguínea , Enfermedades Vasculares/etiología , Enfermedades Vasculares/virología , Activación ViralRESUMEN
Patients with herpes zoster undergo extensive screening to detect underlying malignant disease which is compromising their immunity. In a retrospective survey of 1000 patients with herpes zoster ophthalmicus 12 patients had malignant disease which was known on presentation. No new cases were detected or discovered on follow-up. Three patients developed a disseminated rash, but none of these had an underlying malignant disease.