medigraphic.com
Academia Mexicana de Neurología, A.C.

2011, Number 6

<< Back Next >>

Rev Mex Neuroci 2011; 12 (6)

Hemorrhagic necrotizing vasculitis associated with varicella-zoster virus infection: A case report and literature review

Cortés-Medina JC, Guerrero-Rascón CA, Martínez-Madrigal F

Language: Spanish
References: 25
Page: 373-377
PDF size: 227.48 Kb.


ABSTRACT

Introduction: Necrotizing vasculitis of the central nervous system due to varicella zoster virus (VZV) infection implicates an infrequent entity due to direct invasion of the blood vessels. The objective is to present the clinical case of a parenchymal hemorrhage associated with herpes zoster cerebral vasculitis. Case report: A 19-year-old man with history of recent VZV infection presents with severe headache, left hemiparesis, a Glasgow coma scale of 9 points, right anisocoria secondary to parenchymal hemorrhage. The histopathological diagnosis was compatible with viral necrotizing vasculitis. Conclusions: Cerebral vasculitis is a rare cause of intracranial hemorrhage that should be suspected in a patient with history of recent VVZ infection. Magnetic resonance imaging and conventional angiography studies are useful elements in the diagnosis; however, they are poor indicators of the presence or vasculitis. Thus, the diagnosis does not rely on a single method, but on the clinical, imagenological and histopathological correlation.


REFERENCES

  1. Arvin AM. Varicella-zoster virus. In: Fields B. (ed.). Virology, 3rd. Ed. New York: Raven Press; 1995, p. 2547-86.

  2. Croen KD, Ostrove JM, Dragovic LJ, Straus SE. Patterns of gene expression and sites of latency in human nerve ganglia are different for varicellazoster and herpes simplex viruses. Proc Natl Acad Sci USA 1988; 85: 9773-7.

  3. Giller RH, Winistorfer S, Grose C. Cellular and humoral immunity to varicella zoster virus glycoproteins in immune and susceptible human subjects. J Infect Dis 1989; 160: 919-28.

  4. Kleinschmidt-DeMasters BK, Amlie-Lefond C, Gilden DH. The patterns of varicella zoster virus encephalitis. Hum Pathol 1996; 27: 927-38.

  5. Gilden DH, Kleinschmidt-DeMasters BK, Wellish M, Hedley-Whyte ET, Rentier B, Mahalingam R. Varicella zoster virus, a cause of waxing and waning vasculitis: the New England Journal of Medicine case 5-1995 revisited. Neurology 1996; 47: 1441-6.

  6. Woolfenden AR, Tong DC, Marks MP, Ali AO, Albers GW. Angiographically defined primary angiitis of CNS. Is it really benign? Neurology 1998; 51: 183-8.

  7. Melanson M, Chalk C, Georgevich L. Varicella-zoster virus DNA in CSF and arteries in delayed contralateral hemiplegia: evidence for viral invasion of cerebral arteries. Neurology 1996; 47: 569-70.

  8. Reshef E, Greenberg SB, Jankovic J. Herpes zoster ophthalmicus followed by contralateral hemiparesis: report of two cases and review of literature. J Neurol Neurosurg Psychiatry 1985; 48: 122-7.

  9. Amlie-LeFond C, Kleinschmidt-DeMasters BK, Mahalingam R, Davis LE, Gilden DH. The vasculopathy of varicella-zoster virus encephalitis. Ann Neurol 1995; 37: 784-90.

  10. Linnemann CC Jr, Alvira MM. Pathogenesis of varicella-zoster angiitis in the CNS. Arch Neurol 1980; 37: 239-40.

  11. Reyes MG, Fresco R, Chokroverty S, Salud EQ. Viruslike particles in granulomatous angitis of the central nervous system. Neurology 1976; 26: 797-9.

  12. Sotrel A. Varicella Zoster Virus and CNS Vasculitis. Neurology1998; 51: 324-5.

  13. Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R,Cohrs RJ. Neurologic complications of varicella zoster virus reactivation. N Engl J Med 2000; 342: 635-46.

  14. Morgello S, Block GA, Price RW. Varicella-zoster virus leukoencephalitis and cerebral vasculopathy. Arch Pathol Lab Med 1988; 112: 173-7.

  15. Dueland AN, Devlin M, Martin JR. Fatal varicella-zoster virus meningoradiculitis without skin involvement. Ann Neurol 1991; 29: 569-72.

  16. Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, et al. The Varicella zoster virus vasculopathies Clinical, CSF, imaging, and virologic; features. Neurology 2008; 70: 853-60.

  17. Hayman M, Hendson G, Poskitt KJ, Connolly MB. Postvaricella angiopathy: report of a case with pathologic correlation. Pediatr Neurol 2001; 24: 387-9.

  18. Kleinschmidt-Demasters BK, Gilden DH. Varicella-zoster virus infections of the nervous system: clinical and pathologic correlates. Arch Pathol Lab Med. 2001; 125: 770-80.

  19. Luqmani RA, Bacon PA, Moots RJ, Janssen BA, Pall A, Emery P, et al. Birmingham Vasculitis Activity Score (BVAS) in systemic necrotizing vasculitis. Q. J Med 1994; 87: 671-8.

  20. Yoong MF, Blumbergs PC, North JB. Primary (granulomatous) angiitis of the central nervous system with multiple aneurysms of spinal arteries. J Neurosurg 1993; 79: 603-7.

  21. De Reuck J, Crevits L, Sieben G. Granulomatous angiitis of the nervous system: a clinicopathological study of one case. J Neurol 1982; 277: 49-53.

  22. Shibata S, Mori K, Sekine I, Suyama H. [An autopsy case of subarachnoid and intracerebral hemorrhage and necrotizing angitis associated with methamphetamine abuse]. No To Shinkei 1988; 40: 1089-94.

  23. Takeoka M, Takahashi T. Infectious and inflammatory disorders of the circulatory system and stroke in childhood. Curr Opin Neurol. 2002; 15: 159-64.

  24. Greenan TJ, Grossman RI, Goldberg HI. Cerebral vasculitis: MR imaging and angiographic correlation. Radiology 1992; 182: 65-72.

  25. Duna GF, Calabrese LH. Limitations of invasive modalities in the diagnosis of primary angiitis of the central nervous system. J Rheumatol 1995; 22: 662-67.




2020     |     www.medigraphic.com