Recurrent hemiplegia associated with cerebral vasculopathy following third trimester maternal herpes zoster infection

Abstract

The chickenpox virus (varicella zoster virus; VZV) is known to cause large and small vessel central nervous system vasculopathies that may be associated with strokes in both adults and children. We present the case of a female aged 2 years 6 months who developed a chronic progressive small‐vessel vasculopathy with radiological features of moyamoya disease as a manifestation of congenital varicella syndrome. Clinically, the condition was characterized by recurrent ischaemic strokes, which were brought under control using intravenous acyclovir. The case is unique in that it is the first report of congenital varicella syndrome to occur after a maternal herpes zoster infection. Furthermore, it is the first case of symptomatic VZV infection in a child to occur after a maternal infection occurring in the third trimester of pregnancy.

Aortic dissection and moyamoya disease in Turner syndrome

“…Epidemiological evidence suggests a genetic predisposition in the Asian population and incidence of diagnosis peaks in two age groups: children who are 5 years of age and adults in their mid‐40s [Scott and Smith, 2009]. Evidence exists that environmental factors may influence the phenotypic expression of the disease [Scott et al, 2004; West et al, 2006; Kuroda and Houkin, 2008; Scott and Smith, 2009]. In an epidemiologic study of TS outcome, there were four deaths (1.8 expected) from cerebrovascular disease, which included hemorrhage [Stochholm et al, 2006], but none with moyamoya (C.H.…”

Chickenpox, Measles, and Mumps

“…Only six cases occurring after maternal zoster have been reported [248,249,278,279,284]; not all of these are well documented virologically. Four occurred after maternal zoster in the first trimester, one followed zoster in the second trimester [278], and one followed zoster in the third trimester [284]. Of 109 reported affected infants, 103 (95%) cases followed maternal varicella, and 6 (5%) followed maternal zoster (disseminated in one instance).…”

“…Most reported cases of congenital varicella syndrome have occurred when the onset of maternal infection was before the 20th week of pregnancy. Only seven infants with some of the stigmata have been recorded as the result of maternal varicella after the 20th week [175,211,[245][246][247]255,284]. When maternal varicella occurs after the 20th week, the infant may be infected, but usually the only evidence is a positive VZV antibody titer when the infant is older than 1 year and, in some cases, development of zoster at an early age.…”

Common Features Between Stroke Following Varicella in Children and Stroke Following Herpes Zoster in Adults

“…To further define features of varicella-related stroke in children, we reviewed over 60 case reports of stroke following varicella. These reports span the decades before varicella vaccination was commonly administered, so all cases are considered to be wild-type varicella virus (Losurdo et al 2006;Eda et al 1983;Liu and Holmes 1990;Caekebeke et al 1990;Bodensteiner et al 1992;Ichiyama et al 1990;Shuper et al 1990;Tucciarone et al 1992;Yilmaz et al 1998;Hausler et al 1998;Silverstein and Brunberg 1995;Hayman et al 2001;Okanishi et al 2009;Rougeot et al 2006;Danchaivijitr et al 2006;Ueno et al 2002;Kimura et al 2002;Gomez-Gosalvez et al 2003;Beleza et al 2008;Hayes et al 2007;Lopez Medina et al 2002;West et al 2006;Tiah et al 2004;Guillot et al 2005;Morino et al 2009;Yaramis et al 2009;Singhal et al 2001;Aydin et al 2006;Cadavid et al 1999;Leis and Butler 1987;Kramer et al 1999;Darling et al 1995;Wieting et al 1997;Frank et al 1989;Spiegel et al 2010;Walker et al 1973;Hansen et al 2006;Nguyen et al 1994;Alehan et al 2002;…”