Dados do Trabalho

Título

STROKE MIMIC SECONDARY TO VACICELA ZOSTER VIRUS ENCEPHALITIS

RESUMO

CASE PRESENTATION: FEMALE, 77 YEARS OLD, HYPERTENSIVE AND CORONARIOPATHY, SEARCHED OUR SERVICE AFTER BEING FOUND SLEEPY, DISORDERED AND WITH ALTERATION OF SPEECH. ON ADMISSION, IT WAS EVALUATED BY THE NEUROLOGY TEAM, WHICH CONFIRMED APHASIA. A CT SCAN OF THE SKULL WAS PERFORMED, WHICH SHOWED AN ASYMMETRY OF DENSITY BETWEEN THE INSULAE, WHICH, TOGETHER WITH THE SUDDEN FOCAL DEFICIT, STRENGTHENED THE DIAGNOSTIC HYPOTHESIS OF HYPERACUTE ISCHEMIC BRAIN VASCULAR ACCIDENT, BEING THROMBOLYTIC TREATMENT WITH ALTEPLASE AND THE PATIENT REFERRED TO THE ISCHEMIC STROKE UNIT. THE FOLLOWING DAY, THE PATIENT WAS SLEEPY AND ENCEPHALOPATHY, WHEN ULCERATED LESIONS COVERED BY SEROHEMATICAL CRUSTS AND LESIONAL HYPEREMIA WERE NOTICED, LOCATED IN THE FRONT REGION ON THE RIGHT, IN THE TERRITORY OF THE OPHTHALMIC BRANCH OF THE TRIGEMINAL NERVE, THE DIAGNOSTIC HYPOTHESIS OF HERPES-ZOSTER BEING PROPOSED. LUMBAR PUNCTURE PERFORMED WHICH EVIDENCED CELLULARITY OF 201 (66% LYMPHOCYTES AND 19% MONOCYTES), PROTEIN 31 MG/DL AND GLUCOSE 52 MG/DL, IN ADDITION TO MULTIPLEX PCR CONFIRMED VARCELLA ZOSTER VIRUS INFECTION. THE MRI AND ANGIO-MRI BRAIN SHOWED LESION WITH RESTRICTION TO LEFT PARIETAL DIFFUSION. TREATMENT WITH ACYLOVIR STARTED AND IN 48 HOURS THE PATIENT EVOLVED WITH IMPROVEMENT OF SYMPTOMS. DISCUSSION: THE VARICELLA ZOSTER VIRUS CAUSES CHICKENPOX AS A PRIMARY INFECTION, AFTER WHICH THE VIRUS BECOMES LATENT IN THE CRANIAL NERVES AND DORSAL ROOT GANGLIA ALONG THE NEUROAXIS. WHEN CELL MEDIATED IMMUNITY DECREASES, THE VIRUS MAY REACTIVATE, TRAVEL PERIPHERALLY TO CAUSE A SKIN ERUPTION AND PERIPHERAL NEUROPATHY (HERPES ZOSTER) OR, LESS COMMONLY, IT MAY MOVE CENTRALLY AND CAUSE A VARIETY OF NEUROLOGICAL COMPLICATIONS, INCLUDING VASCULOPATHY AND ENCEPHALITIS, THESE CAN CAUSE IRREVERSIBLE BRAIN DAMAGE. IN THE CASE IN QUESTION, THE APPARENT ISCHEMIC LESIONS ON MRI DID NOT JUSTIFY THE PATIENT'S INITIAL SYMPTOMS, BEING TREATED AS STROKE MIMIC SECONDARY TO ENCEPHALITIS FRAMEWORK BY VZV. THIS AGENT IS SUSCEPTIBLE TO VARIOUS ANTIVIRAL DRUGS, BUT ACYCLOVIR IS THE DRUG OF CHOICE AND ITS EARLY INITIATION HAS CONTRIBUTED TO AVOIDING SERIOUS COMPLICATIONS IN THE CASE IN QUESTION. CONCLUSION: THERE IS A LARGE QUANTITY OF DISEASES THAT CAN BEHAVE LIKE STROKE MIMIC, VZV ENCEPHALITIS IS ONE OF THEM, THAT SHOULD BE SUSPECTED, ESPECIALLY, WHEN THERE IS CLINICAL ACUTE ENCEPHALOPATHY ASSOCIATED WITH SUGGESTIVE SKIN LESIONS. TIMELY TREATMENT CAN PREVENT SERIOUS SEQUELAE.

Palavras Chave

VARICELA ZOSTER VIRUS; MIMIC STROKE; ENCEPHALITIS