Department of Medicine, University of Cape Town.
S Afr Med J. 2012 Mar 2;102(6):474-6. doi: 10.7196/samj.5470.
We present a case and discuss stroke related to human immunodeficiency virus (HIV) infection and the difficulties of reaching a firm diagnosis of the cause of the aneurysmal vasculopathy. In the absence of a clear aetiology we suggest looking for varicella zoster virus (VZV) replication in the cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) and treating with intravenous acyclovir, aiming for HIV control with appropriate antiretroviral therapy and providing suitable antiplatelet agents. If there is a high index of suspicion of VZV, therapy with acyclovir may be prudent even if the CSF PCR is negative (as may occur after the first 2 weeks of reactivation of infection). Determination of a VZV plasma:CSF IgG ratio is not readily available and would only provide surrogate support for a previous VZV infection in the central nervous system compartment.
我们呈现了一例与人类免疫缺陷病毒（HIV）感染相关的中风病例，并讨论了明确病因诊断的困难。由于病因不明，我们建议通过聚合酶链反应（PCR）在脑脊液（CSF）中寻找水痘带状疱疹病毒（VZV）的复制，并使用静脉用阿昔洛韦进行治疗，同时通过适当的抗逆转录病毒治疗控制 HIV，并提供合适的抗血小板药物。如果高度怀疑 VZV，则即使 CSF PCR 为阴性（感染复发后前 2 周可能出现这种情况），阿昔洛韦治疗也可能是谨慎的。VZV 血浆：CSF IgG 比值的测定并不方便，并且仅能为中枢神经系统中以前的 VZV 感染提供替代支持。
