Postvaricella angiopathy: report of a case with pathologic correlation.
Varicella is a common childhood illness, and central nervous system complications occur frequently. Delayed angiopathy has been described, although there are few reports of clinicopathologic correlation. A previously well 4-year-old male is presented. He suffered varicella 2 months before presentation with extensive right middle cerebral artery (MCA) territory infarction. Cerebral angiography demonstrated an isolated 89% stenosis of the right proximal MCA. He developed cerebral edema refractory to medical treatment and progressed to transtentorial herniation. Right frontal temporoparietal craniotomies were performed with evacuation of infarcted brain tissue. Pathologic studies revealed small vessel vasculitis with lymphocytic infiltration of the vessel wall. Areas of demyelination were present within the white matter. Polymerase chain reaction for varicella was negative on brain tissue. Postvaricella angiopathy, although an uncommon complication, may affect both small and large blood vessels, with catastrophic results.
Hayman
M
M
Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H 3V4, Canada.
Hendson
G
G
Poskitt
K J
KJ
Connolly
M B
MB
D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery; D002644:Chickenpox / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002675:Child, Preschool; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D020768:Middle Cerebral Artery / Q000473:pathology / Q000601:surgery; D009186:Myelin Sheath / Q000473:pathology; D009474:Neurons / Q000473:pathology; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery