Shingles, an unusual cause of stroke
6th International Conference on Neurology and Neuroscience
June 11-13, 2018 | London, UK
Kerry Badger, Ruth A Mizoguchi and Vongai Mugadza
Chelsea & Westminster NHS Foundation Trust, UK
Scientific Tracks Abstracts : J Brain Neurol
VZV (Varicella Zoster Virus) infection in humans is a well-documented entity that is linked to numerous neurological complications, including intraceberal vasculitis. This can lead to ischaemic or haemorrhagic stroke and is a major cause of morbidity and mortality. This complication is more common in immunocompromised or elderly individuals. We present a case of haemorrhagic stroke presenting in an individual with recent onset VZV reactivation. An 83-year-old woman, who was previously living independently, presented to hospital with an acute onset of delirium and expressive dysphasia. This presentation was on the background of a 3 weeks history of an evolving vesicular rash in the dermatomal distribution of the ophthalmic branch of trigeminal nerve, characteristic of herpes zoster opthalmicus. The patient was started on oral acyclovir 3 days prior to admission and initial diagnosis of delirium secondary to herpes zoster infection was made. On admission, she scored 4 /10 on the abbreviated mental test score (AMTS), had a positive Hutchinson’s sign and an unremarkable neurological examination. Laboratory testing showed raised inflammatory markers. Subsequent CT and MR brain imaging revealed a right temporal lobe haemorrhage with interventricular extension. Further imaging of the CT angiogram showed widespread vessel narrowing, consistent with vasculitis or a differential diagnosis of widespread atheromatous disease. Cerebral spinal fluid (CSF) polymerase chain reaction (PCR) was positive for VZV and further vasculitic screening including ANA and ANCA was negative. A diagnosis of haemorrhagic stroke secondary to varicella zoster vasculitis was made and the patient was treated with high dose intravenous methylprednisolone and acyclovir. It is important to consider viral induced cerebral vasculitis in susceptible patient groups as a cause of stroke. Correctly identifying patients presenting with this complication allows treatment with steroids and anti-viral agents that have been found to increase chances of a better prognosis.
Kerry Badger is a Foundation Doctor currently working at Chelsea and Westminster Hospital NHS Foundation Trust. She achieved a Bachelor of Medical Sciences in 2015 and a Bachelor of Medicine and Surgery in 2017, both from the University of Nottingham. She has a developing interest in neurology and has recently completed a rotation on a combined stroke, neurology and geriatric ward.
E-mail: [email protected]