Abstract
The role of Varicella zoster virus (VZV) in neurological illness, particularly cerebrovascular disease, has been increasingly recognized. Primary infection by VZV causes varicella (chickenpox), after which the virus remains latent in neuronal ganglia. Later, during aging or immunosuppression, the virus can reactivate causing zoster (shingles). Virus reactivation can also spread to cerebral arteries causing vasculitis and stroke. Zoster is a recognized risk factor for stroke, but stroke can occur without preceding zoster rash. The diagnosis of VZV cerebral vasculitis is established by abnormal brain imaging and confirmed by presence of viral DNA or anti-VZV antibodies in cerebrospinal fluid. Treatment with acyclovir with or without prednisone is usually recommended. VZV vasculitis is a unique and uncommon stroke mechanism that has been under recognized. Careful diagnostic investigation may be warranted in a subgroup of patients with ischemic stroke to detect VZV vasculitis and initiate appropriate therapy. In the following review, we detail the clinical presentation of VZV vasculitis, diagnostic challenges in VZV detection, and suggest the ways to enhance recognition and treatment of this uncommon disease.
| Original language | English (US) |
|---|---|
| Journal | Neurohospitalist |
| DOIs | |
| State | Published - Jan 1 2019 |
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Keywords
- central nervous system
- ischemic stroke
- Varicella zoster virus
- vasculitis
ASJC Scopus subject areas
- Clinical Neurology
Cite this
Varicella Zoster Virus Vasculitis and Adult Cerebrovascular Disease. / Bakradze, Ekaterina; Kirchoff, Kathryn F.; Antoniello, Daniel; Springer, Mellanie V.; Mabie, Peter C.; Esenwa, Charles C.; Labovitz, Daniel L.; Liberman, Ava L.
In: Neurohospitalist, 01.01.2019.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Varicella Zoster Virus Vasculitis and Adult Cerebrovascular Disease
AU - Bakradze, Ekaterina
AU - Kirchoff, Kathryn F.
AU - Antoniello, Daniel
AU - Springer, Mellanie V.
AU - Mabie, Peter C.
AU - Esenwa, Charles C.
AU - Labovitz, Daniel L.
AU - Liberman, Ava L.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - The role of Varicella zoster virus (VZV) in neurological illness, particularly cerebrovascular disease, has been increasingly recognized. Primary infection by VZV causes varicella (chickenpox), after which the virus remains latent in neuronal ganglia. Later, during aging or immunosuppression, the virus can reactivate causing zoster (shingles). Virus reactivation can also spread to cerebral arteries causing vasculitis and stroke. Zoster is a recognized risk factor for stroke, but stroke can occur without preceding zoster rash. The diagnosis of VZV cerebral vasculitis is established by abnormal brain imaging and confirmed by presence of viral DNA or anti-VZV antibodies in cerebrospinal fluid. Treatment with acyclovir with or without prednisone is usually recommended. VZV vasculitis is a unique and uncommon stroke mechanism that has been under recognized. Careful diagnostic investigation may be warranted in a subgroup of patients with ischemic stroke to detect VZV vasculitis and initiate appropriate therapy. In the following review, we detail the clinical presentation of VZV vasculitis, diagnostic challenges in VZV detection, and suggest the ways to enhance recognition and treatment of this uncommon disease.
AB - The role of Varicella zoster virus (VZV) in neurological illness, particularly cerebrovascular disease, has been increasingly recognized. Primary infection by VZV causes varicella (chickenpox), after which the virus remains latent in neuronal ganglia. Later, during aging or immunosuppression, the virus can reactivate causing zoster (shingles). Virus reactivation can also spread to cerebral arteries causing vasculitis and stroke. Zoster is a recognized risk factor for stroke, but stroke can occur without preceding zoster rash. The diagnosis of VZV cerebral vasculitis is established by abnormal brain imaging and confirmed by presence of viral DNA or anti-VZV antibodies in cerebrospinal fluid. Treatment with acyclovir with or without prednisone is usually recommended. VZV vasculitis is a unique and uncommon stroke mechanism that has been under recognized. Careful diagnostic investigation may be warranted in a subgroup of patients with ischemic stroke to detect VZV vasculitis and initiate appropriate therapy. In the following review, we detail the clinical presentation of VZV vasculitis, diagnostic challenges in VZV detection, and suggest the ways to enhance recognition and treatment of this uncommon disease.
KW - central nervous system
KW - ischemic stroke
KW - Varicella zoster virus
KW - vasculitis
UR - http://www.scopus.com/inward/record.url?scp=85065196606&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065196606&partnerID=8YFLogxK
U2 - 10.1177/1941874419845732
DO - 10.1177/1941874419845732
M3 - Review article
AN - SCOPUS:85065196606
JO - The Neurohospitalist
JF - The Neurohospitalist
SN - 1941-8744
ER -