Varicella-zoster vasculitis presenting with intracranial hemorrhage

Abstract

Cerebral vasculitis presenting with intracranial hemorrhage is a rare but known entity. We discuss here the case of a 61-year-old woman presenting with subarachnoid hemorrhage. Cerebral angiography showed vasculitic changes involving the small and medium-sized vessels. She also had a concomitant herpes zoster rash on her back. A 3-month follow-up angiogram revealed partial resolution of the vasculitic changes.

Fig 1.

Axial CT, showing subarachnoid hemorrhage, mainly in the anterior interhemispheric fissure (B) and left para-midline hematoma (A).

Fig 2.

Lateral (A) and anteroposterior oblique (B) left internal carotid arteriograms and right internal carotid lateral (C) arteriograms, showing multiple scattered segments (arrows) of irregularity and narrowing involving the small and medium-sized vessels.

Fig 3.

Left (A) and right (B) internal carotid lateral arteriograms (3 months’ follow-up), showing partial resolution of the vasculitic changes and persistence of some of the narrowed segments (arrowheads).