Barreau Ariana, Lu Jeffrey, Weis Blake, Mikhail Fadi
Carle Illinois College of Medicine, Urbana, Illinois, USA
Carle Illinois College of Medicine, Urbana, Illinois, USA.
Pract Neurol. 2025 Mar 14;25(2):164-167. doi: 10.1136/pn-2024-004335.
A 66-year-old woman reported 10 days of generalised weakness, falls and memory 'glitches'. She had developed left-sided ophthalmic herpes zoster 3 months before but was otherwise well. MR scan of brain showed acute left-sided ischaemic strokes and CT cerebral angiogram identified marked stenoses of the left anterior and middle cerebral arteries. We suspected varicella-zoster virus vasculopathy, confirmed by cerebrospinal fluid analysis. Initially she had further ischaemic strokes despite intravenous acyclovir, prednisone, aspirin and clopidogrel. However, after prolonged acyclovir and prednisone, there were no new infarcts though imaging of left anterior and middle cerebral artery vessel walls showed persistent inflammation. Varicella zoster vasculopathy can cause recurrent ischaemic strokes, even in immunocompetent people with no cardiovascular risk factors, and despite long-term antiviral therapy.
一名66岁女性报告称有10天全身乏力、跌倒及记忆“差错”。她3个月前患左侧眼部带状疱疹，除此之外身体状况良好。脑部磁共振成像扫描显示左侧急性缺血性中风，脑部CT血管造影显示左侧大脑前动脉和大脑中动脉明显狭窄。我们怀疑是水痘-带状疱疹病毒血管病变，脑脊液分析证实了这一点。起初，尽管使用了静脉注射阿昔洛韦、泼尼松、阿司匹林和氯吡格雷，她仍进一步发生缺血性中风。然而，在长期使用阿昔洛韦和泼尼松后，虽左侧大脑前动脉和大脑中动脉血管壁成像显示炎症持续存在，但未出现新的梗死灶。水痘-带状疱疹病毒血管病变可导致复发性缺血性中风，即使在没有心血管危险因素的免疫功能正常人群中也是如此，且尽管进行了长期抗病毒治疗。
