RESUMEN
We present a clinical case of a patient with SARS-CoV-2 infection and respiratory symptoms, complicated with a pro-thrombotic state involving multiple vascular territories and concomitant interleukin-6 increase. This case underlines the possibility to develop a COVID-19-related coagulopathy.
Asunto(s)
COVID-19/complicaciones , Infarto de la Arteria Cerebral Media/virología , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2RESUMEN
Herpes simplex virus 2 (HSV-2) is a very rare cause of central nervous system (CNS) infections. We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-2 DNA was identified by PCR, with a positive viral load in favor of active replication. No other viral or microbiological infections were identified. MRI angiography confirmed a vasculitic process involving the left carotid artery, and a HSV-2 vasculitis diagnosis was assumed. The patient started acyclovir with improvement of clinical features and imaging abnormalities. In the HIV-infected patient, stroke is a multifactorial common cause of morbidity. The physician should take into account a broad differential diagnosis including rare causes and atypical presentations of common etiologies, including HSV-1 and HSV-2 CNS infection.
Asunto(s)
Infecciones por VIH/inmunología , Herpes Simple/inmunología , Huésped Inmunocomprometido , Infarto de la Arteria Cerebral Media/inmunología , Accidente Cerebrovascular Isquémico/inmunología , Vasculitis/inmunología , Aciclovir/uso terapéutico , Terapia Antirretroviral Altamente Activa , Antivirales/uso terapéutico , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/virología , Femenino , Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Herpes Simple/diagnóstico por imagen , Herpes Simple/tratamiento farmacológico , Herpes Simple/virología , Herpesvirus Humano 2 , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Infarto de la Arteria Cerebral Media/virología , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/virología , Angiografía por Resonancia Magnética , Cooperación del Paciente , Vasculitis/diagnóstico por imagen , Vasculitis/tratamiento farmacológico , Vasculitis/virología , Carga Viral/efectos de los fármacos , Adulto JovenRESUMEN
Survivin, a member of the inhibitors of apoptosis protein gene family, inhibits the activity of caspase, leading to a halt of the apoptotic process. Our study focused on the neuroprotective effect of survivin after transient middle cerebral artery occlusion (MCAO) with intraparenchymal administration of an adeno-associated virus (AAV) vector. His-tagged survivin was cloned and packaged into the AAV-rh10 vector. Four-week-old Sprague-Dawley rats were injected with 4 × 109 vg of AAV-GFP or AAV-His-survivin into the right striatum and were treated 3 weeks later with transient MCAO for 90 min. Twenty-four hours after MCAO, functional and histological analyses of the rats were performed. The result showed that rats that had been treated with AAV-green fluorescent protein (GFP) and those that had been treated with AAV-His-survivin did not show a significant difference in neurological scores 24 hr after MCAO, however, infarction volume was significantly reduced in the AAV-His-survivin group compared to that in the AAV-GFP group. Although the neutrophil marker myeloperoxidase did not show a significant difference in the ischemic boundary zone, cells positive for active caspase-3 and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling were significantly decreased in the AAV-His-survivin group. In conclusion, survivin overexpression in the ischemic boundary zone induced by using an AAV vector has the potential for amelioration of ischemic damage via an antiapoptotic mechanism.
Asunto(s)
Isquemia Encefálica/virología , Infarto de la Arteria Cerebral Media/virología , Fármacos Neuroprotectores/farmacología , Survivin/metabolismo , Animales , Apoptosis/efectos de los fármacos , Isquemia Encefálica/metabolismo , Dependovirus/genética , Modelos Animales de Enfermedad , Etiquetado Corte-Fin in Situ/métodos , Infarto de la Arteria Cerebral Media/fisiopatología , Masculino , Ratas Sprague-Dawley , Survivin/genéticaRESUMEN
Among infectious factors, varicella-zoster virus (VZV) is a leading cause of central nervous system vasculopathy and stroke in childhood. Not only have viral markers been detected in the cerebrospinal fluid of affected patients, but also direct evidence of viral particles in the wall of cerebral arteries has been demonstrated in rare pathological specimens. This certainly reflects a localized infectious process likely associated with variable indirect inflammatory responses. Yet the usefulness in this setting of a lumbar puncture as well as of subsequent targeted antiviral and/or anti-inflammatory therapies is uncertain. Indeed, in the majority of cases, the so-called post-varicella angiopathy has a monophasic evolution with spontaneous resolution or stabilization, explaining diverging diagnostic and treatment approaches. In this paper, we have addressed this problematic area by reviewing 26 published cases from the year 2000 and three unpublished cases. Post-varicella stroke is typically associated with angiopathy most often involving the initial portion of the middle cerebral artery, causing a basal ganglia stroke. It tends to occur in young immunocompetent children. Thrombophilia work-up is in general negative. Lumbar puncture was performed in 17 out of 29 cases. Viral markers were examined in 14 cases, but were positive in only eight cases. Antiviral therapy was administrated in 11 children. In this small retrospective study, the treated children's vasculopathy did not progress more favorably nor was there a better outcome compared with untreated subjects.
Asunto(s)
Varicela/complicaciones , Accidente Cerebrovascular/virología , Enfermedades de los Ganglios Basales/virología , Enfermedades Arteriales Cerebrales/virología , Niño , Preescolar , Humanos , Lactante , Infarto de la Arteria Cerebral Media/virología , Imagen por Resonancia Magnética/métodos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapiaRESUMEN
Varicella zoster virus (VZV) has been known to cause cerebral arterial vasculopathy and an acquired antibody-mediated coagulopathy associated with purpura fulminans and generalized thromboembolism. There are no published reports of cerebral venous sinus thrombosis (CVST) associated with primary VZV infection. We report 2 cases that highlight an unusual presentation of VZV infection: CVST with primary varicella infection. One patient had extensive CVST with coexistent middle cerebral artery involvement. Primary VZV infection can be associated with thrombosis of cerebral arteries and venous sinuses.
Asunto(s)
Arterias Cerebrales/virología , Herpes Zóster/virología , Herpesvirus Humano 3/aislamiento & purificación , Trombosis de los Senos Intracraneales/virología , Adolescente , Anticoagulantes/uso terapéutico , Antivirales/uso terapéutico , Angiografía Cerebral/métodos , Arterias Cerebrales/patología , Imagen de Difusión por Resonancia Magnética , Herpes Zóster/complicaciones , Herpes Zóster/diagnóstico , Herpes Zóster/tratamiento farmacológico , Humanos , Infarto de la Arteria Cerebral Media/virología , Angiografía por Resonancia Magnética , Masculino , Flebografía/métodos , Trombosis de los Senos Intracraneales/diagnóstico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Resultado del Tratamiento , Adulto JovenRESUMEN
A case is reported of HIV-associated thrombotic thrombocytopenic purpura with normal CD4 count but high HIV viral load, developing neurological and cardiac complications up to 36 days after initiation of plasma exchange, but remitting within 18 days of the start of highly active antiretroviral therapy and steroids. In addition to plasma exchange, prompt initiation of highly active antiretroviral therapy in patients with HIV-associated thrombotic thrombocytopenic purpura may be justified despite a normal CD4 count.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Infecciones por VIH/tratamiento farmacológico , Púrpura Trombocitopénica Trombótica/virología , Carga Viral , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Humanos , Infarto de la Arteria Cerebral Media/virología , Persona de Mediana Edad , Isquemia Miocárdica/virología , Intercambio Plasmático , Púrpura Trombocitopénica Trombótica/terapia , Esteroides/uso terapéuticoRESUMEN
We report a case of hemiconvulsion-hemiplegia (HH) syndrome. An 18-month-old female infant had a hemiconvulsion followed by left hemiplegia. Magnetic resonance imaging immediately after the onset of hemiplegia showed high intensity in the right hemisphere in diffusion-weighted images (DWI), while T1- and T2-weighted images were normal. Single photon emission computed tomography showed hypoperfusion of the right hemisphere in the acute phase. Virological analyses proved primary human herpesvirus 7 (HHV-7) infection. DWI are useful for the early evaluation of HH syndrome. Vascular disorders due to HHV-7 infection may have been related to the development of HH syndrome in this patient.
Asunto(s)
Trastornos Cerebrovasculares/virología , Hemiplejía/virología , Herpesvirus Humano 7/aislamiento & purificación , Infecciones por Roseolovirus/complicaciones , Convulsiones/virología , Vasculitis del Sistema Nervioso Central/virología , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/patología , Corteza Cerebral/fisiopatología , Trastornos Cerebrovasculares/patología , Trastornos Cerebrovasculares/fisiopatología , Imagen de Difusión por Resonancia Magnética , Femenino , Hemiplejía/patología , Hemiplejía/fisiopatología , Humanos , Lactante , Infarto de la Arteria Cerebral Media/patología , Infarto de la Arteria Cerebral Media/fisiopatología , Infarto de la Arteria Cerebral Media/virología , Arteria Cerebral Media/patología , Arteria Cerebral Media/fisiopatología , Arteria Cerebral Media/virología , Tomografía de Emisión de Positrones , Infecciones por Roseolovirus/diagnóstico , Infecciones por Roseolovirus/fisiopatología , Convulsiones/patología , Convulsiones/fisiopatología , Vasculitis del Sistema Nervioso Central/patología , Vasculitis del Sistema Nervioso Central/fisiopatologíaRESUMEN
We report a 4-year-old child who developed hemiplegia 6 months after varicella-zoster virus (VZV) infection. Cerebral angiography showed complete occlusion of the right middle cerebral artery with basal moyamoya vessels. Elevation of anti-VZV antibody in the cerebrospinal fluid indicated central nervous system involvement. The association between VZV cerebral angitis and unilateral occlusion of right middle cerebral artery is discussed.