Pathogenesis of Varicella-Zoster Angiitis in the CNS

Linnemann, Calvin C.; Alvira, Mariano M.

doi:10.1001/archneur.1980.00500530077013

Cited by 206 publications

(45 citation statements)

References 7 publications

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“…31 In adults with herpes zoster ophthalmicus (HZO) and delayed cerebral infarction, VZ virus is present within the media of the affected large cerebral arteries. 28,[32][33][34] The distribution of vascular lesions in varicella-associated AIS in large cerebral arteries is similar and matches the anatomic location and density of trigeminal innervation at the circle of Willis.…”

Section: Discussionsupporting

confidence: 57%

Chickenpox and Stroke in Childhood

Askalan

Laughlin

Mayank

et al. 2001

Stroke

314

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Background and Purpose-The purpose of this study was to determine whether infection with varicella is causal for arterial ischemic stroke (AIS) in children. Methods-First, a prospective cohort study was conducted in young children (aged 6 months to 10 years) with AIS at 2 institutions (cohort study). The presence of varicella infection Ͻ12 months before AIS was determined and compared with the published frequency of varicella infection in the healthy pediatric population. The clinical and radiographic features of AIS were compared between the varicella and nonvaricella study cohorts. Second, a literature search of varicella-associated AIS was conducted, and the clinical and radiographic features were compared with the study nonvaricella cohort. Results-In the cohort study, 22 (31%) of 70 consecutive children with AIS had a varicella infection in the preceding year compared with 9% in the healthy population. Children in the varicella cohort were more likely to have basal ganglia infarcts (PϽ0.001), abnormal cerebral vascular imaging (PϽ0.05), and recurrent AIS or transient ischemic attacks (PϽ0.05) than those in the nonvaricella cohort. The pooled literature analysis of 51 cases of varicella-associated AIS showed similar findings to the varicella cohort. Conclusion-In young children with AIS, there is a 3-fold increase in preceding varicella infection compared with published population rates, and varicella-associated AIS accounts for nearly one third of childhood AIS. Varicellaassociated AIS has characteristic features, including a 2-fold increase in recurrent AIS and transient ischemic attacks. Varicella is an important risk factor for childhood AIS.

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Section: Discussionsupporting

confidence: 57%

Chickenpox and Stroke in Childhood

Askalan

Laughlin

Mayank

et al. 2001

Stroke

314

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“…Histologically, GACNS may be difficult to distinguish from herpetic angiitis [20,108,109] and other giant cell angiitides such Takayasu's arteritis (pulseless disease) or GCA. In herpetic angiitis, however, an antecedent her petic eruption and subsequent contralateral hemiparesis is usual.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…The simultaneous occurrence of CNS angiitis and herpes zoster virus infection is well recognized [18-20, 108, 109]. Contralateral hemiplegia may occur within a few weeks of onset of herpes zoster ophthalmi cus and pathological studies have demonstrated changes consistent with GACNS as the likely cause for the delayed neurological deficit [20,108]. Herpes-virus-like particles have been identified in glial cells [59] and involved cerebral blood vessels [108].…”

Section: Aetiologymentioning

confidence: 99%

Isolated Angiitis/Angiopathy of the Central Nervous System

Hankey¹

1990

Cerebrovasc Dis

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One hundred cases of isolated angiopathy of the central nervous system (CNS) have been described, the majority of whom (71%) were diagnosed histologically. The pathological findings were those of angiitis, most frequently granulomatous angiitis. These patients should be classified as isolated angiitis of the CNS. The minority of patients (29%) were diagnosed according to clinical and angiographic findings which lack sensitivity and specificity. They represent a heterogeneous group, comprising several cases of probable isolated angiitis of the CNS, some clinical and angiographic syndromes associated with acute hypertension, subarachnoid haemorrhage or migraine and other more obscure ''entities'' such as post-partum cerebral angiopathy and isolated benign cerebral angiopathy. In the absence of a histological diagnosis, it is preferable to classify them as isolated angiopathy of the CNS. Although isolated angiitis of the CNS can be considered a discrete, or at least definable, subset of isolated angiopathy of the CNS, it is unclear whether it is a specific disorder or part of a spectrum of disease or even one of a number of reactions to various antigens. The finding of granulomatous angiitis of the CNS (GACNS) in several patients with various systemic disorders suggests that GACNS may be a non-specific pathological reaction. Until the last decade, the prognosis of isolated angiitis of the CNS was extremely poor. Most patients now survive and return to active lives. The major influence on outcome appears to have been the use of combination corticosteroid and cyclophosphamide therapy, although no randomized controlled trials have been undertaken. Before prolonged treatment with such potent medication is prescribed, it recommended that other causes of CNS vasculitis be carefully excluded and the diagnosis of isolated angiitis of the CNS be established histologically by combined leptomeningeal and parenchymal biopsy. The risks of biopsy would not appear to exceed those of untreated isolated angiitis of the CNS. Multicentre collaboration of interested groups should be encouraged if controlled therapeutic trials are to be achieved.

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“…Wright et al 35 postulated that the necrosis could be the result of ischemia related to an infarction of vessels supplying the teeth. Direct invasion of blood vessels by virus spreading from adjacent cranial nerves 36 and segmental granulomatous vasculitis, associated with HZ infection, with multifocal infarcts in the brain and spinal cord 37 have been reported. Therefore, it has been suggested 35,38 that, considering the close anatomical relationship between virus-infected fifth cranial nerve branches and blood vessels, this vasculitic component may contribute to the infarction of the vessels.…”

Section: Discussionmentioning

confidence: 99%