acyclovir and Intracranial-Aneurysm

We report a case of varicella-zoster vasculopathy that occurred in a 42-year-old renal transplant recipient with concurrent vertebral artery aneurysm and dissection. The patient was successfully treated with embolization and acyclovir therapy. Here, we review the English literature regarding the association of varicella-zoster virus infection with cerebral aneurysm.

Topics: Acyclovir; Adult; Anticoagulants; Antiviral Agents; Embolism; Herpes Zoster; Herpesvirus 3, Human; Humans; Intracranial Aneurysm; Male; Vertebral Artery

Intracranial aneurysms in the pediatric population are relatively rare entities. Immunocompromised patients (often from HIV/AIDS or pharmacological immunosuppression) represent a significant fraction of children with cerebral aneurysms. One proposed mechanism of aneurysm formation in these patients is from direct infection of the affected arteries. In this study, the authors report on a case of a 14-year-old girl with common variable immunodeficiency with T-cell dysfunction and a CSF polymerase chain reaction test positive for varicella-zoster virus who underwent evaluation for carotid and basilar artery fusiform aneurysms.

Topics: Acyclovir; Adolescent; Aneurysm; Angiography, Digital Subtraction; Antiviral Agents; Aspirin; Basilar Artery; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Common Variable Immunodeficiency; Female; Herpes Zoster; Humans; Image Processing, Computer-Assisted; Intracranial Aneurysm; Magnetic Resonance Angiography; Platelet Aggregation Inhibitors; T-Lymphocytes; Tomography, X-Ray Computed; Valacyclovir; Valine; Vasculitis; Vertebral Artery

We describe three cases of cerebral angiopathy with aneurysms caused by a meningeal varicella-zoster virus infection occurring during AIDS. The clinical picture was rather stereotyped: severe immunocompromission due to HIV infection, ongoing multifocal cerebrovascular disease with territorial infarcts, lymphocytic meningitis with normal glucose content (two cases) or hypoglycorrhachia (one case), multifocal cerebral vasculopathy with narrowings and aneurysms, healing with or without neurological sequelae after intravenous aciclovir treatment. The diagnosis of varicella-zoster virus-induced angiopathy was ascertained by the positive specific PCR in the CSF in the three cases and by the results of the cerebromeningeal biopsy in one case. Although, varicella-zoster virus is already known as a cause of cerebral angiopathy both in the immunocompetent and the immunocompromised, these three cases are the first ever described of a particular angiopathy with narrowings and ectasias complicating AIDS. The infectious treatable cause and the risk of aggravation without treatment require early active oriented investigations in case of a patient with cerebrovascular disease occurring during HIV infection, including a CSF study with varicella-zoster PCR, to allow specific antiviral treatment. In our three cases, aciclovir intravenous treatment (30mg/kg per day) enabled VZ virus clearing from the CSF and stopped the course of the vasculopathy.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Angiography; Chickenpox; Female; Glucose; HIV Infections; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography; Male; Meningitis, Viral; Reverse Transcriptase Polymerase Chain Reaction; Vasculitis, Central Nervous System