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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare case of ischemic stroke related to Herpes zoster infection of the eye and documented arteritis in an HIV-positive patient is analyzed. The woman, aged 32, who was born in Angola and lived in Zaire, was diagnoses at the Hospital Universitario de Santa Maria, Lisbon. She presented with a 5-month history of sudden hemiplegia, 4 months after onset of herpes zoster ophthalmicus. Among extensive diagnosis tests, she was positive for HIV by ELISA and Western blot, hepatomegaly, and generalized lymphadenopathy. She has left Herpes zoster ophthalmicus with ptosis bulbi and mottled discoloration of the skin over the distribution of the 1st division of the left trigeminal nerve, and right spastic hemiparesis. Her helper T-cell count was 952/cubic mm, and her T-cell ratio was 0.9. She had anemia, hypoalbuminemia, positive serology for cytomegalovirus, Herpes simplex, Epstein Barr virus, and hepatitis B. She had no bacterial infections, but her stool contained Trichuris trichiura eggs and giardia lamblia cysts. Her cardiovascular system and cerebrovascular fluid were negative. Computed tomography of the head showed an old left capsular infarct. Cerebral angiography showed arteritis of the left choroidal artery with occlusion. She was treated with metronidazole and mebendazole, and had surgery for removal of the left eye with a prosthetic replacement. Strokes are common in AIDS patients, resulting from fungal infections, endocarditis, infectious or non-infectious emboli, or arteritis from herpes zoster infections. This is the 1st published case of hemiplegia and Herpes zoster in a European or African patient with HIV-1.
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PMID:Herpes zoster and controlateral hemiplegia in an African patient infected with HIV-1. 186 23

A case of occipital infarction following herpes zoster involving the maxillary division of the trigeminal nerve is presented. Herpes zoster ophthalmicus is followed occasionally by an angiitis and cerebral infarction, usually manifest as a hemiplegia. Cerebral angiitis has not been reported previously following herpes zoster involving the maxillary or mandibular divisions. Patients with herpes zoster involving any trigeminal division may be at risk for delayed stroke. The distribution of rash and angiitis in this case supports the hypothesis that the virus extends directly to the large vessels adjacent to the gasserian ganglion, instead of being transmitted along intracranial nerves.
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PMID:Herpes zoster maxillaris with delayed occipital infarction. 294 67

The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty-five cases have been reported to date, and the authors' experience with two additional cases seen in a one-year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non-neurologist. Diagnostic and therapeutic considerations are reviewed.
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PMID:Herpes zoster ophthalmicus and granulomatous angiitis. An ill-appreciated cause of stroke. 348 27

A sixty-nine year old man suffered a stroke fourteen weeks after the onset of right herpes zoster ophthalmicus (HZO). Hemispheric infarction was documented by a computed tomography which showed a small hypodense zone in the right internal capsula; after contrast there was enhancement of this hypodense area. Cerebral angiography and cerebral-spinal fluid were not done. Despite of a diagnosis of probability the authors report the case and review the literature. A long latency between the HZO and onset of neurological deficit is stressed. New antiviral agents may prevent the ictus.
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PMID:[Ocular herpes zoster and delayed cerebrovascular accident: report of a case]. 633 29

Herpesviruses cause various acute, subacute, and chronic disorders of the central (CNS) and peripheral (PNS) nervous systems in adults and children. Both immunocompetent and immunocompromised individuals may be affected. Zoster (shingles), a result of reactivation of varicella zoster virus (VZV), is the most frequent neurologic complication. Other neurological complications include encephalitis produced by type I herpes simplex virus (HSV-1), and less frequently HSV-2, as well as by VZV and cytomegalovirus (CMV). Acute meningitis is seen with VZV and HSV-2, and benign recurrent meningitis with HSV-2. Combinations of meningitis/ encephalitis and myelitis/radiculitis are associated with Epstein Barr Virus (EBV); myelitis with VZV, CMV, EBV, and HSV-2; and ventriculitis/encephalitis with VZV and CMV. Brainstem encephalitis due to HSV and VZV, and polymyeloradiculitis due to CMV are well documented. HHV-6 produces childhood exanthem subitum (roseola) and febrile convulsions. Immunocompetent and immunocompromised hosts manifest different incidences and patterns of herpesvirus infections. For example, stroke due to VZV-mediated large vessel disease (herpes zoster ophthalmicus) occurs predominantly in immunocompetent hosts, while small vessel disease (leukoencephalitis) and ventriculitis develop almost exclusively in immunocompromised patients. EBV-associated primary CNS lymphomas also are restricted to immunosuppressed individuals. Recent large CSF PCR studies have shown that VZV, EBV, and CMV more frequently produce meningitis, encephalitis, or encephalopathy in immunocompetent hosts than was formerly realized. We review herpesvirus infections of the nervous system and illustrate the expanding spectrum of disease by including examples of a 75-year-old male on steroid treatment for chronic lung disease with fatal HSV-2 meningitis and an 81-year-old male with myasthenia gravis, long-term azathioprine use, and an EBV-associated primary CNS lymphoma.
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PMID:The expanding spectrum of herpesvirus infections of the nervous system. 1155 90

The trigeminal trophic syndrome is a rare complication following central or peripheral injury of the trigeminal nerve typically characterized by unilateral distribution of anaesthesia, paraesthesia and ulceration. In one third of cases it is preceded by an iatrogenic damage of the trigeminal nerve, in another third by a history of stroke. Other causes include head trauma, intracranial tumours, herpes virus infection, degenerative diseases of the CNS and idiopathic. Little is known about the pathogenesis. Contribution of neurotrophic factors and an altered sympathetic activity is assumed but a pivotal role of self-mutilation is generally accepted. We report a case of a patient who developed a strictly unilateral crescent ulcer of the ala nasi in addition to an extensive ulceration of the forehead and scalp following herpes zoster ophthalmicus.
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PMID:Trigeminal trophic syndrome with extensive ulceration following herpes zoster. 1905 25

We present a case of childhood arterial ischemic stroke associated with proven adenoviral upper respiratory tract infection in a previously healthy 4-year-old boy. Adenoviral meningitis and encephalitis have been reported repeatedly, thus confirming the neuroinvasive capability of these viruses. However, an association between adenoviral infection and arterial ischemic stroke has not been described thus far. HIV and varicella zoster virus are the only microorganisms that have been consistently associated with arterial ischemic stroke in the absence of acute central nervous system infection. In HIV-infected individuals ischemic stroke can be caused by vasculitis and hypercoagulability. Granulomatous arteritis of the vessel wall causes post-varicella cerebral infarction and ischemic stroke after herpes zoster ophthalmicus. We suggest that in our patient a post-varicella cerebral infarction-like mechanism of adenoviral spread to the affected artery wall occurred through the ophthalmic branch of the trigeminal nerve. Adenoviruses are neuroinvasive and inflamed conjunctiva might have permitted introduction of the virus into ophthalmic nerve tissue. In consequence, the stenotic lesion of the artery might have been induced by the presence of adenovirus and the subsequent inflammatory reaction. We recommend a prompt quest for adenoviral infection in all previously healthy children with fever and clinical presentation compatible with ischemic stroke, because timely diagnosis and treatment could improve the outcome and hasten neurological recovery.
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PMID:Ischemic stroke associated with adenoviral infection in a 4-year-old boy. 2004 16

This editorial will assess a proposed link between herpes zoster ophthalmicus and subsequent stoke. Herpes zoster (also called shingles) is caused by varicella-zoster virus (VZV), one of the 9 human herpesviruses. When children contract their primary VZV infection, virus often travels to the trigeminal ganglia and establishes latency. Upon reactivation in late adulthood, the same virus travels anterograde to cause herpes zoster ophthalmicus. In some people, the virus also traffics from the same trigeminal ganglion along afferent fibers around the carotid artery and its branches. Subsequently VZV-induced inflammation within the affected cerebral arteries leads to occlusion and stroke. In one retrospective analysis of people with herpes zoster ophthalmicus, there was a 4.5 fold higher risk of stroke than in a control group. Two other studies found a less compelling association.
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PMID:Reassessing the link between herpes zoster ophthalmicus and stroke. 2467 19

Ischemic stroke is a recognized complication of herpes zoster ophthalmicus. Arterial involvement is usually seen on the side of the rash. It is thought to be due to vessel inflammation by the virus, which travels from the trigeminal ganglion. Few case reports of bilateral and distant site of zoster lesions with stroke in the brain have been described. These reports suggest possibility of contiguous vascular, cerebrospinal fluid (CSF) or hematogenous spread of the virus from the ganglion to the cerebral blood vessels. Therapeutically acyclovir, anticoagulation, and steroids have been used in the treatment of the zoster associated with stroke. We describe a case of immunocompromised patient with ipsilateral zoster ophthalmicus with bilateral anterior circulation strokes, who was treated with above measures and made successful recovery. This report also raises/supports possible CSF/vascular/hematogenous spread of the virus from the ganglion to involve cerebral blood vessels leading to the stroke.
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PMID:Unilateral herpes zoster ophthalmicus with bilateral cerebral infarcts in human immunodeficiency virus seropositive patient. 2500 67

Infections are rare but important causes of stroke. Among these, varicella zoster virus has been known to cause ischemic stroke. During an attack of herpes zoster ophthalmicus, it has been hypothesized that the virus replicates in the trigeminal ganglion and travels via the trigeminal nerve centrally to cause cerebral vasculopathy. Here we present a case of a 69 year-old Caucasian immunocompromised woman who suffered recurrent ischemic infarcts within the same vascular distribution following an episode of zoster ophthalmicus three months prior. An imaging technique termed black-blood magnetic resonance imaging was utilized to aid in the diagnosis of cerebral vasculitis. The case is used to provide a literature review of the pathogenesis, diagnosis, and treatment of cerebral varicella zoster vasculopathy. In situations where an isolated unilateral cerebral vasculopathy is identified, neurologists are urged to consider varicella zoster as a treatable etiologic agent, as untreated vasculopathy can lead to further strokes.
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PMID:Varicella-Zoster Virus Vasculopathy: A Case Report Demonstrating Vasculitis using Black-Blood MRI. 2706 14


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