acyclovir and Stroke

A 72-year-old Japanese woman was treated by 3000 mg/day of valacyclovir for the herpes zoster in her left back. She had been treated as hypertension with no renal insufficiency. In two days, she visited an emergency room of a regional stroke care center with dysarthria, dexterity disorder and gait disturbance. Neither head CT nor MRI found intracranial lesions, then, laboratory tests revealed that her serum creatinine level was 4.63 mg/dL. She was transferred and admitted to our hospital on the following day and received hemodialysis under the diagnosis of AKI due to acyclovir accompanied with encephalopathy. Afterward, her serum concentration of acyclovir revealed as 44 μg/mL, which is extremely high. Her neurological symptom disappeared in parallel with the decrease of serum concentration of acyclovir. She received 3 sessions of hemodialysis and discharged on the 8th day of admission with almost normal renal function and no neurological sequela.

Topics: Acute Kidney Injury; Acyclovir; Aged; Antiviral Agents; Female; Humans; Kidney; Stroke; Valacyclovir

Topics: Acyclovir; Adult; Encephalitis, Herpes Simplex; Female; Herpes Simplex; Humans; Magnetic Resonance Imaging; Migraine Disorders; Paralysis; Stroke; Young Adult

To examine risk factors associated with cerebrovascular accident (CVA) following herpes zoster ophthalmicus (HZO).. Retrospective cohort study.. Review of medical records of all patients with HZO seen at the department of Ophthalmology, Auckland District Health Board, New Zealand, between January 1, 2006, and December 31, 2016. The main outcome measure was cerebrovascular accident within 12 months of diagnosis.. A total of 869 patients diagnosed with HZO were included in the study. The median age at onset of HZO was 65.5 years (interquartile range [IQR] 52.9-75.4), and 52.5% (n=456) were male. Antiviral therapy was started in 765 participants (88.0%), not used in 95 (10.9%), and not documented in 9 participants (1.0%). Four hundred sixty-eight participants (54.9%) received prompt oral antiviral therapy (≤72 hours of rash onset). A CVA occurred in the 12 months following HZO in 14 patients (1.6%) and was most common in older patients, occurring in 2.5% aged ≥65 years, 0.7% aged 40-65 years, and 0.9% aged <40 years. Hazard of CVA was highest immediately following HZO, with median time to CVA of 2.3 months (IQR 0.8-5.9 months). Patients who received prompt acyclovir had a 76.2% lower hazard of CVA (0.9% vs 2.6%, P = .022) on multivariate analysis.. Cerebrovascular accident occurs in a low proportion of individuals within 1 year following HZO. Antiviral treatment for HZO may reduce the risk of subsequent CVA when given within 72 hours of rash onset.

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster Ophthalmicus; Humans; Male; Retrospective Studies; Stroke

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

Varicella zoster virus is a Deoxyribonucleic acid (DNA) virus exclusively affecting humans. Reactivation of varicella zoster virus causes herpes zoster with vesicular eruptions in a restricted dermatomal distribution. Peripheral motor neuropathy is a very rare complication of varicella zoster virus.. A 57-year-old previously well Sri Lankan female presented with acute onset painful weakness of the left upper limb with a preceding history of a febrile illness. Subsequently she developed vesicular eruptions in the dermatomal distribution of cervical 5, 6, and 7. Electromyography was suggestive of acute denervation of cervical 5, 6, and 7 myotomes. Diagnosis of zoster-associated brachial plexopathy was made, and the patient was treated with acyclovir, steroids, and analgesics. She made a good recovery.. Brachial plexus neuritis due to varicella zoster infection should be considered in an acute monoparesis of a limb as it is a treatable and reversible condition.

Topics: Acyclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Middle Aged; Paralysis; Stroke

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

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

Topics: Acyclovir; Antiviral Agents; Aphasia; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Stroke

Topics: Acyclovir; Administration, Intravenous; Adult; Antiviral Agents; Diplopia; Female; Herpesvirus 3, Human; Humans; Stroke; Treatment Outcome; Varicella Zoster Virus Infection

A 73-year-old woman presented with sudden onset of right hemiparesis and was diagnosed as having cerebral infarction on the basis of diffusion-weighted brain MRI, which demonstrated lesions in the left parietal cortex. On the 3rd day, the patient developed right upper limb myoclonus, aphasia, and disturbance of consciousness with high fever. On the 6th day, she was transferred to our hospital with suspected viral encephalitis, and treatment with acyclovir was started. By the 6th day, the lesions detected by MRI had expanded to the gyrus cinguli, insula and thalamus, but not to the temporal lobe. At that time, the CSF cell count was 8/μl, and this later increased to 17/μl by the 13th day. Although herpes simplex virus DNA was detected in the CSF on the 6th day, there was no evidence of CSF pleocytosis or temporal lobe abnormalities demonstrable by brain MRI throughout the whole follow-up period. This was very atypical case of herpes simplex encephalitis characterized by a stroke-like episode, atypical MRI findings, and absence of cerebrospinal fluid pleocytosis. It is important to be mindful that herpes simplex encephalitis (HSE) can have an atypical presentation, and that sufficient acyclovir treatment should be initiated until HSE can be ruled out.

Topics: Acyclovir; Aged; Antiviral Agents; Biomarkers; Brain; Clonazepam; DNA, Viral; Drug Therapy, Combination; Encephalitis, Herpes Simplex; Female; Humans; Leukocytosis; Levetiracetam; Magnetic Resonance Imaging; Methylprednisolone; Neuroimaging; Piracetam; Simplexvirus; Stroke

Varicella zoster (VZ) vasculopathy is a rare but well recognized cause of stroke. In the absence of zoster rash and infection in remote past, the disease can pose diagnostic challenge. We report 3 cases of anterior circulation stroke occurring in close temporal relation to VZ. Their clinical, radiologic, and angiographic features are discussed.. Of the 3 patients, 2 had stroke within a span of 4 to 6 weeks of herpes zoster ophthalmicus while the third patient had zoster of cervical dermatome. Magnetic resonance imaging revealed acute subcortical infarcts in 2, while 1 patient showed acute on chronic infarct in left middle cerebral artery territory. The magnetic resonance angiography was abnormal in 2 patients while it was normal in third. All the patients were treated with acyclovir and antiplatelets with good recovery in 2.. VZ associated vasculopathy may have diverse clinical profile and neuroimaging features. It should be considered as an important and treatable cause of stroke in appropriate clinical settings.

Topics: Acyclovir; Antiviral Agents; Brain; Female; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Stroke; Treatment Outcome

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 simplex virus type 2 (HSV-2) meningitis dogmatically is benign and self-limited in the immune competent patient. However, we describe how left untreated HSV-2 meningitis can be complicated by vasculitis and both ischemic and hemorrhagic stroke. We report a 57-year-old woman with lymphocytic meningitis complicated by ischemic stroke and intracerebral hemorrhage in the setting of vasculopathy and HSV-2 DNA detected in CSF successfully treated with acyclovir and corticosteroids. Subsequent angiographic magnetic resonance imaging revealed improvement in the vasculopathy after treatment. This case demonstrates that HSV-2 meningitis may take a less benign course and further provides the first evidence of angiographic improvement in addition to clinical improvement after definitive treatment.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Meningitis, Viral; Middle Aged; Stroke; Vasculitis

Acute isolated sphenoid sinusitis is a relatively uncommon entity. Because its symptoms and clinical findings are nonspecific, it can be easily misdiagnosed. Left unrecognized and untreated, it can lead to several well-known and severe complications, including meningitis, cerebral abscess, cavernous sinus thrombosis, and epidural or subdural empyema. We report the case of a 28-year-old woman with acute sphenoid sinusitis complicated by ischemic stroke in the left caudate nucleus, lentiform nucleus, and posterior part of the internal capsule. The stroke was diagnosed on magnetic resonance imaging. Also, magnetic resonance angiography showed a narrowing of the internal carotid artery and a narrowing of the first part of the left anterior and middle cerebral arteries (A1 and M1 segments). The patient was treated with medical therapy, including antibiotics, and surgical drainage of the sphenoid sinus via an endoscopic approach. Her outcome was good, and she experienced minimal neurologic sequelae. We discuss the possible explanations for this rare complication.

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Anticoagulants; Antiviral Agents; Carotid Artery Diseases; Cefotaxime; Dalteparin; Dexamethasone; Female; Glucocorticoids; Humans; Magnetic Resonance Angiography; Sphenoid Sinusitis; Stroke; Tomography, X-Ray Computed; Vancomycin

Viral encephalitis is associated with significant morbidity and mortality, particularly when appropriate management is omitted as a result of delayed diagnosis. A case of herpes simplex virus type 1 (HSV-1) encephalitis is presented, demonstrating that the presentation of confusion, speech difficulties and fever with non-specific early brain CT appearances can easily be misdiagnosed as pneumonia with stroke. This case highlights the need for increased awareness of HSV-1 encephalitis among emergency physicians and radiologists, given that the early spectrum of clinical and CT findings can mimic the more common diagnoses of sepsis and stroke.

Topics: Acyclovir; Aged, 80 and over; Confusion; Diagnosis, Differential; Encephalitis, Herpes Simplex; Female; Herpesvirus 1, Human; Humans; Stroke; Treatment Outcome

The etiology of stroke in young patients is often unknown. Although systemic infections as well as specific infection agents, like herpes zoster virus or cysticercus, are often considered as risk factors, there are no indications that herpes simplex type 1 plays a role in the pathogenesis of stroke. We present the case of a young patient who suffered a stroke during a meningoencephalitis due to herpes simplex 1 and we review the relevant literature for a possible relation between the two entities.

Topics: Acyclovir; Adult; Antiviral Agents; Encephalitis, Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Male; Meningoencephalitis; Stroke

Acute retinal necrosis syndrome (ARN syndrome) is a rare viral disease with a poor prognosis in most cases. It is characterized by substantial ocular inflammation with progressive retinal necrosis, occlusive vasculitis and sometimes extraocular features.. We report the case of a 62-year-old woman who was referred for a suspicion of a stroke. Ophthalmological examination revealed a profound bilateral visual loss due to extensive retinal necrosis. The patient was immediately treated with antiherpetic drugs. ARN syndrome with meningoencephalitis caused by herpes simplex virus type 2 was confirmed by PCR studies performed on aqueous humor and cerebrospinal fluid. Herpes simplex virus 2 (IgG+ , IgM-) was probably reactivated after intrathecal injection of steroids because of pain associated with narrowing of the lumbar vertebral canal. The patient was treated with intravenous Acyclovir for 3 weeks. After 4 months, both retinas were detached.. ARN syndrome caused by herpes simplex virus 2 most often occurs after reactivation of the latent virus in patients with a neurological medical history or congenital infection. Antiviral treatment must begin early to decrease risks of bilateralization and complications.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; Cerebrospinal Fluid; Dexamethasone; Diagnostic Errors; DNA, Viral; Drug Therapy, Combination; Encephalitis, Herpes Simplex; Female; Ganciclovir; Hemiplegia; Herpesvirus 2, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Polymerase Chain Reaction; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Stroke; Urinary Incontinence; Virus Activation

Cerebral infarcts are rather rare in children and can be caused by a number of diverse conditions. We report a case of cerebral infarct associated with a recent varicella infection. A 5-year old girl presented with an acute central facial palsy 1 month after a chickenpox infection. The infarction was revealed by magnetic resonance imaging and laboratory studies ruled out all known causes of stroke. Cerebral angiogram demonstrated segmental narrowing and irregularity of the wall of the right internal carotid artery, compatible with focal vasculitis. With the presumed diagnosis of varicella-associated focal angiitis, the patient was treated with high-dose methylprednisolone, acyclovir and aspirin. Magnetic resonance angiogram performed 6 weeks after the stroke demonstrated the resolution of the vasculitis. Varicella infection should be considered one of the possible causes of acute ischaemic strokes in children.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Brain; Carotid Arteries; Cerebral Angiography; Chickenpox; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Methylprednisolone; Stroke; Vasculitis, Central Nervous System