title: Post-varicella angiopathy: a series of 4 patients with focus on virologic and neuroimaging findings.
abstract: BACKGROUND
  Post-varicella angiopathy is an important cause of childhood stroke and follows a particular pattern. Specific treatment guidelines have not been developed because of a lack of epidemiological, laboratory, and neuroimaging data. Prospective randomized controlled trials evaluating different treatment strategies have not been performed, and expert opinions on diagnostic criteria, prognosis, and treatment are diverging.
  
  
  METHODS
  This case series describes the clinical course, laboratory, and neuroimaging findings of four children with post-varicella angiopathy, who all underwent cerebrospinal fluid assessment and received antiviral, immunosuppressive, and antiplatelet treatment.
  
  
  RESULTS
  Cerebrospinal fluid analysis was positive for varicella-zoster virus markers in three children. At follow-up, three children had a mild hemiparesis and one child had no neurological symptoms. Neuroimaging showed complete vascular remission in three patients and improvement in one.
  
  
  CONCLUSIONS
  Systematic search for virologic markers in cerebrospinal fluid will contribute to the understanding of the pathogenesis of idiopathic childhood stroke and can be considered as a prerequisite for the development of clear diagnostic criteria and relevant treatment strategies for post-varicella angiopathy. The role of antiviral and immunosuppressive medication needs to be clarified.
authors.affiliation: Department of Pediatrics, Kolding Region Hospital, Denmark.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Dunkhase-Heinl
authors.affiliation: Section of Magnetic Resonance Imaging, Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Brian
authors.initials: B
authors.lastname: Stausbøl-Grøn
authors.affiliation: Department of Radiology, Kolding Region Hospital, Denmark.
authors.forename: Johnny
authors.initials: J
authors.lastname: Christensen
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark. Electronic address: rarejohn@gmail.com.
authors.forename: John R
authors.initials: JR
authors.lastname: Ostergaard
mesh_terms: D015415:Biomarkers / Q000134:cerebrospinal fluid; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D002644:Chickenpox / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D010291:Paresis / Q000134:cerebrospinal fluid / Q000209:etiology / Q000473:pathology / Q000628:therapy; D020521:Stroke / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: angiopathy; children; outcome; stroke; treatment; varicella zoster