Post-Varicella Angiopathy: A Series of 4 Patients With Focus on Virologic and Neuroimaging Findings

Abstract Background Post-varicella angiopathy is an important cause of childhood stroke and follows a particular pattern. Specific treatment guidelines have not been developed because of a lack of epidemiological, laboratory, and neuroimaging data. Prospective randomized controlled trials evaluating...

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Published in:Pediatric neurology 2014-06, Vol.50 (6), p.581-585
Main Authors: Dunkhase-Heinl, Ulrike, MD, Stausbøl-Grøn, Brian, PhD, Christensen, Johnny, MD, Ostergaard, John R., MD DMSc
Format: Article
Language:English
Subjects:
angiopathy
Biomarkers - cerebrospinal fluid
Brain - pathology
Brain Ischemia - cerebrospinal fluid
Brain Ischemia - etiology
Brain Ischemia - pathology
Brain Ischemia - therapy
Chickenpox - complications
children
Female
Follow-Up Studies
Humans
Infant
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Neurology
outcome
Paresis - cerebrospinal fluid
Paresis - etiology
Paresis - pathology
Paresis - therapy
Pediatrics
stroke
Stroke - cerebrospinal fluid
Stroke - etiology
Stroke - pathology
Stroke - therapy
treatment
Treatment Outcome
varicella zoster
Varicella-zoster virus
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Summary:Abstract Background Post-varicella angiopathy is an important cause of childhood stroke and follows a particular pattern. Specific treatment guidelines have not been developed because of a lack of epidemiological, laboratory, and neuroimaging data. Prospective randomized controlled trials evaluating different treatment strategies have not been performed, and expert opinions on diagnostic criteria, prognosis, and treatment are diverging. Methods This case series describes the clinical course, laboratory, and neuroimaging findings of four children with post-varicella angiopathy, who all underwent cerebrospinal fluid assessment and received antiviral, immunosuppressive, and antiplatelet treatment. Results Cerebrospinal fluid analysis was positive for varicella-zoster virus markers in three children. At follow-up, three children had a mild hemiparesis and one child had no neurological symptoms. Neuroimaging showed complete vascular remission in three patients and improvement in one. Conclusions Systematic search for virologic markers in cerebrospinal fluid will contribute to the understanding of the pathogenesis of idiopathic childhood stroke and can be considered as a prerequisite for the development of clear diagnostic criteria and relevant treatment strategies for post-varicella angiopathy. The role of antiviral and immunosuppressive medication needs to be clarified.
ISSN:0887-8994
1873-5150
DOI:10.1016/j.pediatrneurol.2014.01.019