acyclovir and Memory-Disorders

We describe an extraordinarily protracted case of varicella zoster virus (VZV) multifocal vasculopathy in a man who presented initially with ischemic optic neuropathy and then suffered 4 episodes of stroke manifesting as multi-infarct dementia over a 2-year period. Brain magnetic resonance imaging (MRI) and angiography (MRA) revealed cortical and subcortical infarctions as well as vasculitic occlusion and stenosis. The patient was treated with corticosteroids and later with cyclophosphamide. More than 2 years after the onset of neurological disease, two cerebrospinal fluid (CSF) examinations revealed the presence of anti-VZV IgG antibody with reduced serum-to-CSF ratios of anti-VZV IgG compared with ratios for total IgG and albumin, indicative of intrathecal synthesis of anti-VZV IgG. After definitive diagnosis, immunosuppressive drugs were discontinued and he was treated with intravenous acyclovir; both mental status and gait improved and no further episodes of neurological dysfunction ensued. The favorable outcome in this patient indicates that VZV vasculopathy can be treated successfully even after 26 months. VZV must be considered as a possible cause of neurological disease in any patient with idiopathic multifocal vasculopathy.

Topics: Acyclovir; Aged; Antiviral Agents; Apraxias; Basal Ganglia Cerebrovascular Disease; Cyclophosphamide; Dementia, Multi-Infarct; Disease Progression; Drug Therapy, Combination; Dysarthria; Encephalitis, Varicella Zoster; Gait Disorders, Neurologic; Humans; Magnetic Resonance Angiography; Male; Memory Disorders; Prednisone; Pupil Disorders; Recovery of Function; Thalamus; Valacyclovir; Valine; Vertebrobasilar Insufficiency; Vision Disorders

Although herpes simplex virus type 1 (HSV-1) is the most common cause of sporadic encephalitis in immunocompetent adults, it is an unusual cause of encephalitis in patients with HIV/AIDS. We report the case of a 56-year-old man with recently diagnosed HIV infection who presented with subacute mental status changes, fever, and temporal lobe abnormalities evident on brain imaging. Results of a polymerase chain reaction assay of the cerebrospinal fluid were positive for HSV-1. His course was complicated by 2 episodes of cerebral hemorrhage. He ultimately improved after surgical decompression, treatment with acyclovir, and a switch from a protease inhibitor-based antiretroviral regimen to one including an integrase inhibitor.

Topics: Acyclovir; Antiviral Agents; Cerebral Hemorrhage; Encephalitis, Herpes Simplex; Herpesvirus 1, Human; HIV Infections; Humans; Infusions, Intravenous; Male; Memory Disorders; Middle Aged; Seizures; Tomography, X-Ray Computed