Dados do Trabalho

Título

Post-varicella focal cerebral arteriopathy: a rare cause of ischemic stroke

RESUMO

Case presentation: A 15-years-old male patient presented to the emergency department complaining of sudden-onset left hemiparesis since the previous day. He also complained about left hemibody paresthesias one week before admission. There was no prior history of illness, vaccinations, travel or trauma.However, the parents said that the patient had contact with the sister who had chickenpox months before the event.
Neurological examination revealed complete and disproportionate left hemiparesis, predominantly in the left upper limb, with pyramidal signs. The patient underwent computed tomography, which did not initially reveal any abnormalities, but cranial magnetic resonance revealed signs of ischemia in right basal ganglia and internal capsule and Vessel wall evaluation revealed signs of focal vasculitis in the M1 topography of the right middle cerebral artery. The patient underwent lumbar puncture, which revealed CSF pleocytosis with a predominance of lymphomononuclear cells, serology for Varicella Zoster reagent in the CSF (IgG 1:8) and in the blood (IgG > 5000 and IgM <0.20). The treatment consisted of high doses of corticosteroid therapy (1g of methylprednisolone per day for 5 days) in addition to Acyclovir (800 mg/kg for 14 days) due to evidence of possible underlying Varicella Zoster infection. In evolutionary control imaging, complete resolution of the findings suggestive of vasculitis in ACM D described above was noted.
Discussion: Focal cerebral arteriopathy consists of a vasculitis that affects a specific topography of the cerebral circulation, usually affecting the distal portion of the internal carotid artery and proximal to the middle cerebral artery. Despite several described causes, varicella infection is one of the main causes in pediatric patients or those close to this age group. Vascular inflammation can occur in a para-infectious context or even months after the chickenpox condition. This case demonstrates the importance of investigating not only the patient's history, but also the history of indirect contact with the virus.
Final comments: focal cerebral arteriopathy is a rare cause of stroke that should be kept in mind in young patients and investigation of varicella infection should be performed especially in the younger and pediatric population

Palavras Chave

cerebral arteriopathy, varicella, ischemic stroke