The varicella zoster virus vasculopathies -: Clinical, CSF, imaging, and virologic features
The varicella zoster virus vasculopathies -: Clinical, CSF, imaging, and virologic features
复制标题
DOI：
10.1212/01.wnl.0000304747.38502.e8
复制
发表时间：
2008-03-11
期刊：
影响因子：
9.9
通讯作者：
Gilden, D. H.
中科院分区：
文献类型：
--
作者：
Nagel, M. A.;Cohrs, R. J.;Gilden, D. H.
背景：水痘带状疱疹病毒（VZV）血管病变可导致脑动脉病毒感染继发性中风。并非所有患者在脑缺血或中风前都有皮疹。此外，其他vasculitides产生类似的临床特征和可比的成像，血管造影，和CSF abnormality.Methods：我们回顾了我们的23例已发表的病例和7例未发表的VZV血管病变。结果：30例患者中，19例（63%）出现皮疹，20例（67%）出现脑脊液白细胞增多，29例（97%）出现影像学异常。23例患者的血管造影显示16例（70%）异常。30例患者中，大小动脉受累15例（50%），小动脉受累11例（37%），大动脉受累仅4例（13%）。从皮疹到神经系统症状和体征的平均时间为4.1个月，从神经系统症状和体征到CSF病毒学分析的平均时间为4.2个月。9例（30%）患者的CSF中含有VZV DNA，而28例（93%）的CSF中有抗VZV IgG抗体，在这些患者中，降低血清/CSF的VZV IgG的比例证实intrathecontinesynthesis.Conclusions：皮疹或CSF细胞增多症是不需要诊断水痘带状疱疹病毒（VZV）血管病变，而MRI/CT异常被认为是在几乎所有的患者。大部分患者的大动脉和小动脉混合受累。脑脊液中抗VZVIgG抗体的检测比VZVDNA的检测更敏感（p < 0.001）。确定最佳的抗病毒治疗和同时类固醇治疗的益处有待于更多病例的研究。
Background: Varicella zoster virus (VZV) vasculopathy produces stroke secondary to viral infection of cerebral arteries. Not all patients have rash before cerebral ischemia or stroke. Furthermore, other vasculitides produce similar clinical features and comparable imaging, angiographic, and CSF abnormalities.Methods: We review our 23 published cases and 7 unpublished cases of VZV vasculopathy. All CSFs were tested for VZV DNA by PCR and anti-VZV IgG antibody and were positive for either or both.Results: Among 30 patients, rash occurred in 19 (63%), CSF pleocytosis in 20 (67%), and imaging abnormalities in 29 (97%). Angiography in 23 patients revealed abnormalities in 16 (70%). Large and small arteries were involved in 15 (50%), small arteries in 11 (37%), and large arteries in only 4 (13%) of 30 patients. Average time from rash to neurologic symptoms and signs was 4.1 months, and from neurologic symptoms and signs to CSF virologic analysis was 4.2 months. CSF of 9 (30%) patients contained VZV DNA while 28 (93%) had anti-VZV IgG antibody in CSF; in each of these patients, reduced serum/CSF ratio of VZV IgG confirmed intrathecal synthesis.Conclusions: Rash or CSF pleocytosis is not required to diagnose varicella zoster virus (VZV) vasculopathy, whereas MRI/CT abnormalities are seen in almost all patients. Most patients had mixed large and small artery involvement. Detection of anti-VZV IgG antibody in CSF was a more sensitive indicator of VZV vasculopathy than detection of VZV DNA (p < 0.001). Determination of optimal antiviral treatment and benefit of concurrent steroid therapy awaits studies with larger case numbers.