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. 2014 Jun;16(6):407.
doi: 10.1007/s11908-014-0407-z.

Update on varicella zoster virus vasculopathy

Maria A Nagel  1 , Don Gilden
Affiliations

Update on varicella zoster virus vasculopathy

Maria A Nagel et al. Curr Infect Dis Rep. 2014 Jun.

Abstract

Primary infection of humans with varicella zoster virus (VZV) causes varicella (chickenpox), after which the virus becomes latent in cranial nerve ganglia, dorsal root ganglia and autonomic ganglia along the entire neuraxis. As VZV-specific cell-mediated immunity declines in elderly and immunocompromised individuals, VZV reactivates from one or more ganglia and typically causes herpes zoster (shingles). Zoster may also be complicated by VZV vasculopathy due to productive virus infection of the cerebral arteries. In recent decades, the clinical spectrum of VZV vasculopathy has expanded to include not only transient ischemic attacks and ischemic and hemorrhagic stroke, but also multifocal VZV vasculopathy, with temporal artery infection mimicking giant cell arteritis, extracranial vasculopathy, aneurysm with and without subarachnoid hemorrhage, arterial dissection and dolichoectasia, ischemic cranial neuropathies, cerebral venous sinus thrombosis, spinal cord infarction and peripheral thrombotic disease.

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Figures

Fig. 1
Fig. 1
Protean manifestations of VZV vasculopathy
Fig. 2
Fig. 2
MRI in VZV vasculopathy and myelopathy. a, Multifocal VZV vasculopathy is characterized by superficial and deep-seated lesions, typically at grey-white matter junctions (arrows). b, VZV myelopathy is characterized by longitudinal serpiginous lesions in the spinal cord (arrow). (Permission granted from Neurology Clinical Practice)
Fig. 3
Fig. 3
Diagnosis and treatment of VZV vasculopathy * the same calculation is used to determine intrathecal synthesis of anti-VZV IgM antibody
Fig. 4
Fig. 4
VZV antigen in the temporal artery of a patient with giant cell arteritis. Immunohistochemistry revealed VZV antigen (a red color) in the adventitia (arrow) and its nerve bundles (dashed arrow), as well as in media and intima (not shown) after staining with anti-VZV antibody; no staining was seen using anti-HSV-1 antibody (b) or normal rabbit serum (not shown). 600X. Hematoxylin & eosin staining of cross-section of the temporal (c) revealed extensive inflammation in the adventitia (long black arrow), as well as in the media (short black arrow) and vaso vasorum (dashed black arrow). White arrow spans the thickened intima and points to an occluded lumen. Numerous multinucleated giant cells were seen throughout the artery (insets). 200X. (Permission granted from Journal of Neurological Sciences)
See this image and copyright information in PMC

References

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