title: Unusual trigeminal autonomic pain heralding hemichorea due to zoster sine Herpete vasculopathy.
abstract: BACKGROUND
  Varicella zoster virus primary infection is responsible for chickenpox, whereas secondary infection or reactivation can lead to a variety of clinical scenarios. If latent infection is established in trigeminal ganglion, the reactivation can determine viral migration to cerebral arteries, which causes a cerebral vasculopathy and subsequently an ischemic stroke.
  
  
  METHODS
  Here we report on a child experiencing recurrent episodes of headache mimicking a trigeminal autonomic cephalalgia, in the absence of any skin rash, which were followed by the occurrence of an ipsilateral hemiparesis associated with a choreic movement disorder a month later.
  
  
  RESULTS
  Magnetic resonance angiography showed evidence of a right-sided infarction of basal ganglia and anterior limb of the internal capsule, corresponding to the vascular territory of the recurrent artery of Heubner, as a consequence of a focal varicella zoster virus arteriopathy.
  
  
  CONCLUSIONS
  We suggest that the recognition of this prodromal manifestation, which can be interpreted as a zoster sine herpete, could provide clinicians an extremely useful time window to start promptly with a prophylactic treatment.
authors.affiliation: Department of Neuroscience, University-Hospital of Parma, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Spagnoli
authors.forename: Gaetano
authors.initials: G
authors.lastname: Cantalupo
authors.forename: Benedetta
authors.initials: B
authors.lastname: Piccolo
authors.forename: Davide
authors.initials: D
authors.lastname: Cerasti
authors.forename: Francesco
authors.initials: F
authors.lastname: Pisani
mesh_terms: D002675:Child, Preschool; D002819:Chorea / Q000209:etiology* / Q000821:virology; D005260:Female; D014645:Herpesvirus 3, Human / Q000472:pathogenicity*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D014277:Trigeminal Neuralgia / Q000209:etiology* / Q000821:virology; D031368:Zoster Sine Herpete / Q000150:complications*