The protean manifestations of varicella-zoster virus vasculopathy.
Varicella-zoster virus (VZV) vasculopathy in the central nervous system (CNS) affects large and small cerebral vessels. Large-vessel disease is most common in immunocompetent individuals, whereas small-vessel disease usually develops in immunocompromised patients. In some patients, both large and small vessels are involved. Neurological features are protean. Neurological disease often occurs months after zoster and sometimes without any history of zoster rash. Magnetic resonance imaging (MRI) scanning, cerebral angiography, and examination of cerebrospinal fluid (CSF) with virological analysis are needed to confirm the diagnosis. VZV vasculopathy patients do not always have VZV DNA in CSF, but diagnosis can be confirmed by finding anti-VZV antibody in CSF, along with reduced serum/CSF ratios of VZV immunoglobulin G (IgG) compared to albumin or total IgG. When VZV vasculopathy develops months after zoster, antiviral treatment is often effective.
Gilden
Donald H
DH
Department of Neurology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. don.gilden@uchsc.edu
Mahalingam
Ravi
R
Cohrs
Randall J
RJ
Kleinschmidt-DeMasters
Bette K
BK
Forghani
Bagher
B
D002536:Cerebral Arteries / Q000473:pathology / Q000821:virology*; D006562:Herpes Zoster / Q000473:pathology*; D014645:Herpesvirus 3, Human; D006801:Humans; D008279:Magnetic Resonance Imaging; D014657:Vasculitis / Q000473:pathology / Q000821:virology*