Abstract Details

Title VZV-Induced Central Nervous System Vasculopathy: Clinical, Imaging and Biological Features

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-062

Objective

Describe clinical, imaging and biological features of VZV-induced central nervous system vasculopathy.

Background Varicella zoster virus (VZV) is a neurotropic virus that infects more than 95% of the US population. VZV reactivation is a risk factor for stroke and has been associated with central nervous system (CNS) vasculopathy.

Design/Methods

We reviewed the charts of 24 consecutive patients, from January 2010 until September 2018, with confirmed VZV CNS infection through either intrathecal presence of VZV DNA or intrathecal synthesis of anti-VZV antibodies with clinical signs of CNS involvement.

Results The following neurological diagnoses were established: Ischemic stroke (63%, N=15), intracranial hemorrhage (13%, N=3) and encephalitis (25%, N=6). Recent Zoster infection preceded the neurological event in 42% (N=10) and the average duration was 40.78 days. The most common clinical presentations were encephalopathy (46%, N=11), focal neurological sign (46%, N=11) and headache (38%, N=9). CSF pleocytosis was seen in 67% (N=16) of patients (Lymphocytic predominance in 87%) and elevated protein count in 79% (N=19). Ischemic strokes were multifocal in 65% (N=10) of cases and subcortical in 87% (N=13) with a periventricular confluent pattern of involvement. Angiography was performed in 20 patients including all patients with stroke; anterior circulation was involved in 80% of cases (N=12), segmental vascular narrowing was seen in 45% of cases (N=9) and vessel wall irregularities in 55% (N=11). Circumferential vessel wall enhancement was seen in 58% (N=10) of patients who underwent high resolution MRI vessel wall imaging (N=17).

Conclusions

Multifocal, subcortical, confluent strokes with a periventricular confluent pattern of involvement with associated vessel wall abnormalities including narrowing, irregularities and enhancement should encourage to evaluate for VZV induced CNS vasculopathy.

Authors/Disclosures
Jean Khoury, MD (Cleveland Clinic) PRESENTER	Dr. Khoury has nothing to disclose.
Adarsh Bhimraj, MD (Cleveland Clinic)	Dr. Bhimraj has nothing to disclose.
Tracey H. Fan, DO	Dr. Fan has nothing to disclose.
Ken Uchino, MD (Cleveland Clinic Foundation)	Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aboott Laboratories, Inc.. Dr. Uchino has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ACP JOURNAL CLUB. The institution of Dr. Uchino has received research support from NIH.
Sung-Min Cho, DO (Johns Hopkins Hospital)	Dr. Cho has nothing to disclose.

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