acyclovir and Brain-Ischemia

Topics: Acyclovir; Brain Ischemia; Encephalitis, Herpes Simplex; Herpesvirus 2, Human; Humans; Infant, Newborn; Ischemic Stroke; Recurrence; Simplexvirus; Stroke

To describe a term newborn with acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem involvement including seizures associated to ischemic lesions in the brain.. Coronavirus disease 2019 (COVID-19) is predominantly a respiratory infection, but it may affect many other systems. Most pediatric COVID-19 cases range from asymptomatic to mild-moderate disease. There are no specific clinical signs described for neonatal COVID-19 infections. In children, severe central nervous system compromise has been rarely reported.. We describe a 17-day-old newborn who acquired a SARS-CoV-2 infection in a family meeting that was admitted for fever, seizures and lethargy and in whom consumption coagulopathy, ischemic lesions in the brain and cardiac involvement were documented.. SARS-CoV-2 neonatal infection can be associated with multi-organic involvement. In our patient, significant central nervous system compromise associated to ischemic lesions and laboratory findings of consumption coagulopathy were found.. Although neonatal SARS-CoV-2 infections are infrequent, they can be associated with multi-organic involvement. Neonatologists and pediatricians should be aware of this unusual way of presentation of COVID-19 in newborn infants.

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain; Brain Ischemia; Ceftriaxone; COVID-19; COVID-19 Drug Treatment; Fever; Frontal Lobe; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lethargy; Magnetic Resonance Imaging; Male; Nasopharynx; SARS-CoV-2; Seizures

Limited data are available regarding the characteristics and prognosis of patients with stroke due to varicella zoster virus (VZV) vasculopathy.. We studied 4 patients (2 men and 2 women; age, 38-63 years) from a single center who developed acute ischemic stroke due to VZV vasculopathy. The virological diagnosis was confirmed by detecting VZV DNA and/or the IgG antibody to VZV in the cerebrospinal fluid.. Three patients were taking immunosuppressive agents, including prednisolone and/or methotrexate, at baseline. Each patient had a characteristic skin rash prior to stroke, with the interval from rash to stroke onset ranging from 13 to 122 days. Two patients experienced antecedent cranial nerve palsies; one had the third, seventh, ninth, and 10th nerve palsies and the other had the fourth nerve palsy before stroke. Cerebral infarctions were located in the anterior circulation lesion (n = 1), in the posterior circulation lesion (n = 2), and in both lesions (n = 1). Intracranial arterial stenosis was only identified in one patient on magnetic resonance angiography. A high plasma d-dimer level was detected in 1 patient, whereas high β-thromboglobulin and platelet factor 4 levels were detected in 2 patients. As a result of combined therapies with acyclovir, steroid, and antithrombotic agents, neurological symptoms markedly improved in 3 patients, whereas 1 patient was left with moderate hemiplegia.. Cranial nerve palsies may be prodromal symptoms of VZV-associated stroke. Increased levels of thrombotic markers may support the use of antithrombotic agents, although the benefit of combined treatment should be determined through larger studies.

Topics: Acyclovir; Adult; Antiviral Agents; Brain Ischemia; Cranial Nerve Diseases; Diffusion Magnetic Resonance Imaging; Female; Fibrinolytic Agents; Herpesvirus 3, Human; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Retrospective Studies; Steroids; Stroke; Treatment Outcome; Varicella Zoster Virus Infection

Varicella-zoster virus (VZV) is herpes virus that after its reactivation from nerve ganglia to cause herpes zoster may lead to a variety of neurologic complications, including encephalitis, meningitis, retinal necrosis or myelitis. In addition, VZV can spread to arteries in the central nervous system and cause hemorrhagic or ischemic complications due to an inflammatory vasculopathy. In fact, there is a growing epidemiological and clinical recognition that there is an association between VZV reactivation and subsequent strokes. Herein, we present a case of an immune compromised individual with reactivation of VZV causing dermatomal herpes zoster followed by multifocal vasculopathy. We also review the literature to highlight key aspects of VZV-associated vasculopathy.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Brain Ischemia; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Stroke

Herpes zoster is uncommonly followed by cerebral infarction. The pathophysiological mechanism remains uncertain. Outcome is favorable after early specific treatment. We report the case of a 70-year-old woman who developed right hemiparesis with aphasia 15 days after thoracic herpes zoster. The herpes zoster induced cerebral vasculitis was hypothesized as no other etiology could be identified after detailed assessment of the cerebral infarction including brain MRI and cerebrospinal fluid study, and as the clinical course responded to antiviral therapy.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Aphasia; Brain Ischemia; Cerebral Angiography; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Paresis; Vasculitis, Central Nervous System; Vertebrobasilar Insufficiency

Topics: Acyclovir; Adult; Brain Ischemia; Central Nervous System; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Vasculitis