1- Pediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisbon; 2- Pediatric Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisbon; 3- Neurorradiology Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisbon
- 32nd Annual Meeting of the European Society for Paediatric Infectious Diseases ESPID 2014, Dublin, 6-10Mai 2014 (poster)
Introduction: Post varicella arterial ischemic stroke (AIS) is rare and usually a late complication, although it has been reported within the first week of illness. The anterior cerebral circulation and the basal ganglia are commonly affected.
Case report: 3 year-old boy, with β-thalassemia major submitted to bone marrow allotransplant in the previous year and under cyclosporine treatment. Admitted for acute right hemiparesis, right upper-limb dystonia and hyperreflexia at day 2 of varicella. Cranial MRI showed a basal ganglia infarction in the territory of the perforating branches of the middle cerebral artery with no arterial stenosis. PCR for varicella-zoster virus (VZV) was positive in the cerebrospinal fluid. Treatment with intravenous acyclovir was established for 21 days.Transcranial and cervical doppler and cardiologic evaluation were normal. The pro-thrombotic study revealed a transient antiphospholipid syndrome. Concomitant treatment with a platelet aggregation inhibitor (dipyridamole) was initiated. At 6 months follow-up a residual right hemiparesis was still present.
Conclusions: In immunocompromised patients with VZV vasculopathy, the gap between rash and neurological signs may be smaller with positive VZV-DNA in cerebrospinal fluid. Prior to transplant anti-VZV immunization would have been beneficial. The transient antiphospholipid syndrome was probably due to the underlying infection and did not represent a pro-thrombotic risk factor. The signs of acute infarction of the basal ganglia (hypertonia, hyperreflexia and dystonia) may difficult the diagnosis, as they are typically late manifestations of other cerebral areas infarction; therefore obtaining history of recent varicella is important.
Palavras Chave: AVC, varicela, vasculopatia