acyclovir and Infarction--Middle-Cerebral-Artery

Herpes simplex virus 2 (HSV-2) is a very rare cause of central nervous system (CNS) infections. We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-2 DNA was identified by PCR, with a positive viral load in favor of active replication. No other viral or microbiological infections were identified. MRI angiography confirmed a vasculitic process involving the left carotid artery, and a HSV-2 vasculitis diagnosis was assumed. The patient started acyclovir with improvement of clinical features and imaging abnormalities. In the HIV-infected patient, stroke is a multifactorial common cause of morbidity. The physician should take into account a broad differential diagnosis including rare causes and atypical presentations of common etiologies, including HSV-1 and HSV-2 CNS infection.

Topics: Acyclovir; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Female; Herpes Simplex; Herpesvirus 2, Human; HIV Infections; Humans; Immunocompromised Host; Infarction, Middle Cerebral Artery; Ischemic Stroke; Magnetic Resonance Angiography; Patient Compliance; Vasculitis; Viral Load; Young Adult

We report a two-year and one-month-old immunocompetent boy who developed aphasia and right hemiparesis eight months after mild varicella with only a few vesicles. Magnetic resonance images and angiography demonstrated mixed acute and old infarctions of the bilateral middle cerebral arteries. VZV-DNA was detected on polymerase chain reaction analysis of cerebral spinal fluid (CSF). He was treated with intravenous acyclovir and edaravone, and his speech and motor functions had almost recovered after two months. Cerebral lesions of the bilateral middle cerebral artery territories and virus DNA detection from CSF are rare in VZV-related vasculopathy and suggest incomplete immunoresponse to varicella in this patient.

Topics: Acyclovir; Antipyrine; Antiviral Agents; Chickenpox; Child, Preschool; DNA, Viral; Edaravone; Herpesvirus 3, Human; Humans; Infarction, Middle Cerebral Artery; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Blood Coagulation Disorders; Female; Fibrin; Herpes Zoster; Humans; Hyperlipidemias; Infarction, Middle Cerebral Artery; Lymphangiectasis, Intestinal; Middle Aged; Paraproteinemias; Protein S; Protein-Losing Enteropathies; Urinary Tract Infections

Topics: Acyclovir; Aged; Amphotericin B; Aneurysm; Aneurysm, Infected; Anti-Infective Agents; Brain Edema; Carotid Artery Diseases; Carotid Artery, Internal; Ceftriaxone; Dexamethasone; Embolization, Therapeutic; Equipment Contamination; Female; Humans; Imaging, Three-Dimensional; Infarction, Middle Cerebral Artery; Magnetic Resonance Imaging; Meningoencephalitis; Prostheses and Implants; Prosthesis-Related Infections; Tomography, X-Ray Computed