acyclovir and Cerebral-Arterial-Diseases

Background and Purpose- Focal cerebral arteriopathy is monophasic inflammatory stenosis of the distal internal carotid artery or the proximal segment of the middle cerebral artery. It is one of the most common causes of acute arterial ischemic stroke in young children but is a less familiar entity for adult neurologists. Methods- We retrospectively reviewed stroke service radiology records at a tertiary referral center from January 2013 to December 2014. Focal cerebral arteriopathy was defined as nonprogressive unifocal and unilateral stenosis/irregularity of the distal internal carotid artery or its proximal branches. Only patients aged 16 to 55 years with stroke were included. Results- There were 5 cases of focal cerebral arteriopathy: 2 males and 3 females. Three cases were from the cohort of 123 acute presentations of young stroke, and 2 cases were outpatient referrals. The mean age (range) was 43 (32-55) years. The majority presented with recurrent transient ischemic attacks/minor strokes within a single vascular territory over days to weeks. All cases had characteristic radiological features. Interval imaging demonstrated resolution in 1 case and improvement in 3 cases. Functional outcome was excellent with discharge modified Rankin Scale score ranging from 0 to 1. Recurrence occurred in 1 case. Conclusions- Focal cerebral arteriopathy is a rare cause of arterial ischemic stroke in young adults. Follow-up intracranial imaging is essential to differentiate from progressive arteriopathies. Evidence-based treatment warrants further investigation. Prognosis is favorable.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Aspirin; Carotid Artery, Internal; Carotid Stenosis; Cerebral Angiography; Cerebral Arterial Diseases; Computed Tomography Angiography; Dual Anti-Platelet Therapy; Female; Glucocorticoids; Herpesvirus 3, Human; Humans; Immunoglobulin G; Immunoglobulin M; Ischemic Attack, Transient; Male; Middle Aged; Middle Cerebral Artery; Platelet Aggregation Inhibitors; Recurrence; Retrospective Studies; Stroke

Topics: Acyclovir; Adult; Antiviral Agents; Brain Diseases; Central Nervous System Diseases; Cerebral Arterial Diseases; Chickenpox; Fatal Outcome; Fever; Glomerulonephritis; Herpesvirus 3, Human; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Male

A 61-year old man with a history of arterial hypertension suffered a left HZO, and was treated with acyclovir. Three weeks later he suddenly developed moderate left hemiparesis particularly of the leg, severe paresis of the right leg, aphasia and somnolence. Treated with IV acyclovir and high-dose corticosteroids deterioration of the right hemiparesis was apparent. Serological and CSF-studies showed acute varicella-zoster virus infection with intrathecal antibody synthesis (antibody specificity index 2.7). On the third day CT scan revealed infarctions in the territory of both anterior cerebral arteries, at the fifth day additionally left striatocapsular infarction. Selective carotid arteriogram showed bilateral occlusions of anterior cerebral arteries in their proximal segment. With a mean delay of seven weeks granulomatous vasculitis is a rare complication of HZO, leading commonly to ischemic infarctions in the region of the middle cerebral artery. Trigeminovascular connections are the probable pathway of virus-transmission from the trigeminal nerve to ipsilateral branches of the circle of Willis. Because of the presumed pathogenesis immediate therapy with high-dose corticosteroids and acyclovir is justified.

Topics: Acyclovir; Antiviral Agents; Arteritis; Cerebral Angiography; Cerebral Arterial Diseases; Cerebral Infarction; Dominance, Cerebral; Follow-Up Studies; Granuloma; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Tomography, X-Ray Computed

Four patients with herpes zoster ophthalmicus and delayed contralateral hemiparesis are described, and their findings are compared with those in patients previously reported in the English language literature. The current patients evidenced multifocal ipsilateral cerebral angiitis by angiography and multifocal infarcts in the distribution of the ipsilateral middle cerebral artery by computed tomographic scanning. Cerebrospinal fluid showed mononuclear pleocytosis, positive oligoclonal bands, and an elevated immunoglobulin G index. Two patients were treated with corticosteroids and acyclovir, and 1 with corticosteroids alone, all without apparent response. Necrotizing angiitis ipsilateral to the herpes zoster ophthalmicus was demonstrated postmortem in 1 patient with multifocal cerebral infarction and progressive leukoencephalopathy. Neither herpes varicella zoster immunocytochemical reactivity nor viral inclusions were seen. The leukoencephalopathy associated with herpes varicella zoster either may be caused by cerebral angiitis or, as previously reported, may be a temporally remote manifestation of persistent herpes varicella zoster infection. The cerebral angiitis associated with herpes varicella zoster is histologically similar to granulomatous angiitis, and both may be related to herpes varicella zoster infection of the cerebral vasculature.

Topics: Acyclovir; Aged; Brain; Cerebral Arterial Diseases; Cerebral Infarction; Dexamethasone; Dominance, Cerebral; Electroencephalography; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prednisone; Tomography, X-Ray Computed; Vasculitis