González-Suárez Inés, Fuentes-Gimeno Blanca, Ruiz-Ares Gerardo, Martínez-Sánchez Patricia, Diez-Tejedor Exuperio
Department of Neurology, Stroke Center, Neurosciences Area of IdiPAZ Health Research Institute, La Paz University Hospital, Madrid Autonoma University, Spain.
Department of Neurology, Stroke Center, Neurosciences Area of IdiPAZ Health Research Institute, La Paz University Hospital, Madrid Autonoma University, Spain.
J Neurol Sci. 2014 Mar 15;338(1-2):34-8. doi: 10.1016/j.jns.2014.01.009. Epub 2014 Jan 14.
The varicella zoster virus (VZV) is a highly neurotropic virus that, after the primary infection, remains latent in the nerve cells and can reactivate many years later, resulting in various conditions affecting the central nervous system, such as vasculopathy and stroke.
We report on a review of the published literature that included all case reports identified via PubMed and an additional unpublished case of VZV vasculopathy. All epidemiological, clinical, laboratory, imaging, virologic, treatment and outcome data collected are described.
Of the 62 patients, 41.6% were immunocompromised. Ischemic stroke occurred in 77.2% of the patients, comprising cases of isolated (37.1%) and multifocal stroke (17.7%). Multifocal, ischemic and hemorrhagic stroke was only described in the newly reported case. The magnetic resonance imaging results were normal in 2.9% of the cases. The vascular studies (angiography and magnetic resonance angiography [MRA]) revealed signs of angiitis in 74.4% of the cases; the small arteries were involved in 38.5% of the cases, large arteries in 17.7% and mixed in 43.5%. For 95.2% of the patients, the cerebrospinal fluid (CSF) was positive for VZV IgG antibodies, and for 46.1% of the patients, the CSF was positive for polymerase chain reaction (PCR); however, the diagnosis was confirmed in only 3 of 6 biopsies.
VZV vasculopathy can occur in both immunocompetent and immunosuppressed patients. Neuroimaging can reveal stroke and angiitis, and the detection of VZV-specific IgG antibodies in the CSF is a reliable and highly sensitive diagnostic tool. The multifocal nature of VZV vasculopathy makes biopsy a test with low sensitivity and high morbidity.
水痘带状疱疹病毒（VZV）是一种高度嗜神经性病毒，初次感染后，它会潜伏在神经细胞中，并可能在多年后重新激活，导致影响中枢神经系统的各种病症，如血管病变和中风。
我们报告了一项对已发表文献的综述，其中包括通过PubMed检索到的所有病例报告以及1例未发表的VZV血管病变病例。描述了收集到的所有流行病学、临床、实验室、影像学、病毒学、治疗及预后数据。
62例患者中，41.6%为免疫功能低下者。77.2%的患者发生缺血性中风，包括孤立性中风（37.1%）和多灶性中风（17.7%）。仅在新报告的病例中描述了多灶性、缺血性和出血性中风。2.9%的病例磁共振成像结果正常。血管研究（血管造影和磁共振血管造影[MRA]）显示74.4%的病例有血管炎迹象；38.5%的病例累及小动脉，17.7%累及大动脉，43.5%为混合型。95.2%的患者脑脊液（CSF）VZV IgG抗体呈阳性，46.1%的患者脑脊液聚合酶链反应（PCR）呈阳性；然而，6例活检中仅3例确诊。
VZV血管病变可发生于免疫功能正常和免疫抑制的患者。神经影像学可显示中风和血管炎，脑脊液中检测VZV特异性IgG抗体是一种可靠且高度敏感的诊断工具。VZV血管病变的多灶性使得活检成为一种敏感性低且发病率高的检测方法。
