Picard O, Brunereau L, Pelosse B, Kerob D, Cabane J, Imbert J C
Service de Médecine Interne, Hôpital Saint-Antoine, Paris, France.
Biomed Pharmacother. 1997;51(10):449-54. doi: 10.1016/s0753-3322(97)82324-4.
Cases of herpes zoster ophtalmicus (HZO) with delayed contralateral hemiparesis caused by hemispheric stroke secondary to granulomatous angiitis have been reported and are a well-recognized complication of herpes zoster. Similar cases have been reported more recently during infection with human immunodeficiency virus (HIV). We describe two HIV+ patients without any clinical history of zoster dermatitis who developed a sudden hemiparesis followed 2 weeks later for one by an acute retinal necrosis. Computerized tomography (CT) scan, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) were performed and showed a hemispheric stroke with evidence of a segmental arteritis of the carotid syphon. Varicella zoster virus (VZV) was found in the cerebro spinal fluid (CSF) in the two patients and after puncture of the vitreous fluid of the patient with the acute retinal necrosis. These two cases exemplify the difficulty of diagnosis of stroke in HIV+ patients, which seems to be more frequent than in similarly aged non-infected patients and demonstrates that VZV needs to be taken in consideration and identified even without any past history of zoster dermatitis.
已有报告称，由肉芽肿性血管炎继发的半球性卒中导致的伴有延迟性对侧偏瘫的眼带状疱疹（HZO）病例，是带状疱疹一种公认的并发症。最近在人类免疫缺陷病毒（HIV）感染期间也报告了类似病例。我们描述了两名没有带状疱疹性皮炎临床病史的HIV阳性患者，他们突然出现偏瘫，其中一名患者在2周后继而发生急性视网膜坏死。进行了计算机断层扫描（CT）、磁共振成像（MRI）、磁共振血管造影（MRA）和数字减影血管造影（DSA），结果显示为半球性卒中，伴有颈动脉虹吸部节段性动脉炎的证据。在两名患者的脑脊液（CSF）中以及对发生急性视网膜坏死的患者进行玻璃体穿刺后，均发现了水痘带状疱疹病毒（VZV）。这两个病例说明了HIV阳性患者中风诊断的困难，这种情况似乎比年龄相仿的未感染患者更常见，并且表明即使没有带状疱疹性皮炎的既往病史，也需要考虑并识别VZV。
