Borbinha Cláudia, Marto João Pedro, Calado Sofia, Viana-Baptista Miguel
Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Neurology Department, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
Case Rep Neurol. 2016 Jul 7;8(2):145-50. doi: 10.1159/000447296. eCollection 2016 May-Aug.
Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy.
缺血性和出血性中风是水痘带状疱疹病毒（VZV）感染公认的并发症，尽管并不常见且记录较少。作者报告了一名31岁女性的病例，该患者因右大脑后动脉急性缺血性中风入院，1个月前有胸部皮疹病史。给予阿司匹林和辛伐他汀治疗，但患者在接下来的几天里病情逐渐恶化，脑部影像学检查发现有新的梗死区域。尽管没有心脏或大血管栓塞源的证据，但在中风发作6天后开始经验性抗凝治疗。一周后，出现症状性出血转化。随后考虑诊断为VZV血管病变，并开始使用阿昔洛韦和泼尼松龙治疗，此后未再发生血管事件。脑脊液分析和数字减影血管造影结果证实了诊断。患者出院时改良Rankin量表（mRS）评分为4分，前往康复中心。在6个月的随访中，她仅表现出轻微残疾（mRS评分2分）。总之，对于患有中风的年轻人，需要考虑VZV血管病变。高度的怀疑指数和早期治疗对于将发病率和死亡率降至最低似乎很重要。与VZV血管病变相关的中风可能应避免抗凝治疗。
