High-Resolution Vessel Wall Magnetic Resonance Imaging of Varicella-Zoster Virus Vasculopathy Affecting the Vertebrobasilar Artery
Year: 2020
Type: article
Study design: Case Report
Abstract: Varicella-zoster virus (VZV) has been known to cause intracranial vasculopathy, which can result in various cerebrovascular complications such as transient ischemic attack, ischemic and hemorrhagic stroke, aneurysm, and arterial dissection.1,2 Previous studies indicated that the anterior circulation, especially the distal internal carotid or proximal middle cerebral arteries, is frequently affected in VZV vasculopathy.3 We report a case of VZV vasculopathy involving the vertebrobasilar system, which was diagnosed and followed up with high-resolution vessel wall magnetic resonance imaging (HRVW-MRI). CASEA 51-year-old man was admitted with sudden left-sided hemiparesis and dysarthria.He reported no history of chronic illnesses, including cancer or autoimmune diseases.Six weeks prior to the symptoms, he had visited the emergency department with severe headache and a painful blistering rash behind his right ear and posterior neck, leading to a diagnosis of herpes zoster and a 7-day prescription of oral valacyclovir.The initial neurological examination revealed left central-type facial palsy and a pronator drift in the left arm.His left leg weakness was mild, and he could walk without difficulty.The National Institutes of Health Stroke Scale score was 3.Brain magnetic resonance (MR) imaging revealed an acute right pontine infarction on the diffusion-weighted image (Fig. 1A).The susceptibility-weighted image showed a subarachnoid hemorrhage in the prepontine cistern (Fig. 1B, C) and a minimal wall hemorrhage in the right distal vertebral artery (VA).MR angiography revealed severe stenosis of the right distal VA (Fig. 1D).VA dissection was first suspected, and HRVW-MRI was performed to confirm the arterial wall pathology.HRVW-MRI taken 2 days after admission demonstrated severely tapered right distal VA with concentric wall thickening and enhancement, which was strongly suggestive of vasculitis (Fig. 1E).The basilar artery (BA) was patent without any enhancement (Fig. 1F).Given that the vessel wall inflammation may be a pathogenetic factor of arterial dissection, 4 vasculitis was concluded to be the primary cause of VA dissection.Varicella-zoster virus (VZV) has been known to cause intracranial vasculopathy.Herein, we report the case of a patient with VZV vasculopathy involving the vertebrobasilar system who underwent serial high-resolution vessel wall magnetic resonance imaging (HRVW-MRI).The disease continued to worsen radiographically despite clinical symptom improvement.We suggest that VZV vasculopathy may exhibit clinicoradiological dissociation that requires ongoing medical attention.HRVW-MRI may play a critical role in monitoring the disease activity.
Authors: Soomi Cho, Jinkwon Kim, Mina Park, Kyung-Yul Lee
Institutions: Yonsei University, Gangnam Severance Hospital
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3040399998