title: Varicella-zoster vasculitis presenting with cerebellar hemorrhage.
abstract: BACKGROUND
  Varicella zoster virus (VZV) is known as one of the rare, but important, causes of both ischemic and hemorrhagic stroke. Most previously reported VZV-related hemorrhagic stroke and cerebral vasculitis are associated with anterior circulation because VZV spreads from trigeminal ganglia to the anterior circulation of Willis. The present study presents a patient with cerebellar hemorrhage, who was diagnosed with VZV encephalitis and vasculitis of the posterior inferior cerebellar artery.
  
  
  METHODS
  A 75-year-old man with stupor was admitted to our hospital. Computed tomography revealed right intracerebellar hemorrhage, and magnetic resonance imaging revealed multiple high-intense signals throughout the brainstem and temporal lobe on fluid attenuation inversion recovery, suggestive of encephalitis. Cerebral angiography revealed stenosis of left posterior inferior cerebellar artery. Based on cerebrospinal fluid analysis, including anti-VZV IgG antibody and VZV DNA polymerase chain reaction, the patient was diagnosed with VZV encephalitis, vasculitis, and cerebellar hemorrhage.
  
  
  CONCLUSIONS
  Both cerebral vasculitis and hemorrhagic stroke due to VZV can occur in the vertebrobasilar system. VZV may enter the central nervous system not only from trigeminal ganglia but also from other pathways. We should be aware that a VZV infection could cause cerebral vasculitis and hemorrhagic stroke in the vertebrobasilar system and in anterior circulation.
authors.affiliation: Department of Neurosurgery, Hirohata Steel Memorial Hospital, Himeji, Japan. Electronic address: kazukins.vol5@gmail.com.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Neurosurgery, Hirohata Steel Memorial Hospital, Himeji, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Uozumi
authors.affiliation: Department of Neurosurgery, Hirohata Steel Memorial Hospital, Himeji, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Miyamoto
authors.affiliation: Department of Neurosurgery, Hirohata Steel Memorial Hospital, Himeji, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Tatsumi
authors.affiliation: Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kohmura
mesh_terms: D000368:Aged; D002526:Cerebellar Diseases / Q000209:etiology* / Q000473:pathology; D020804:Encephalitis, Varicella Zoster / Q000150:complications* / Q000473:pathology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male
keywords: Varicella zoster; encephalitis; hemorrhagic stroke; vasculitis