VZV-associated vasculitis is a rare cause of stroke in children. Its pathogenesis
is equivocal and no established guidelines for treatment exist. We report the case
of a 5-year-old girl with acute onset of left-sided hemiparesis 2 month after chickenpox
infection. MRI and MR-DWI displayed an acute infarction in the territory of the right
ACI. Cerebral angiography demonstrated a stenosis of the right distal ACI. Over two
weeks, the neurological status improved, but MRA and Doppler sonography revealed increasing
narrowing of the right ACI. In addition, stenosis of the right and left MCA newly
occured. At this time, CSF-examination showed mild pleocytosis and normal protein
content. The VZV-PCR in CSF was negative, but the VZV-specific antibody index was
strongly positive. The girl was treated with acyclovir, prednisolone, azathioprin
and aspirin leading to complete resolvement of neurological symptoms and marked improvement
of cerebral vessel stenosis. The findings in this case suggest a para- or postinfectious
pathogenesis of VZV-associated vasculitis. We conclude that a combined antiviral and
immunosuppressive medication may be a reasonable therapeutic approach for the treatment
of patients with VZV-related stroke.
