Post-varicella arterial ischemic stroke in children: a case report

*Correspondence: [e-mail].

Abstract

Case Presentation: Male patient, one year and eight months old, healthy, with a history of varicella disease within 12 months, was admitted at the hospital on 08/29/2022 with abrupt left hemiparesis. It was solicited for a head computed tomography (CT), with a result showing a subacute ischemic event. The patient presented incomplete disproportionated hemiparesis with predominant left brachial deficit, altered gait, prominent reflexes and muscle strength grade 3 in proximal left hand. It was then started therapy with Acyclovir. A panel for meningitis and encephalitis was made, with negative results. Anticorps Anti-Herpes simplex virus was negative on blood and on liquor. However, the patient showed anticorps IGG anti-varicella positive with high levels in blood. The patient was submitted to magnetic resonance imaging of the brain on 09/21/2022, that showed diffuse tapering and contour irregularity with luminal stenosis compromising the supraclinoid and communicant segments of right internal carotid artery, suggesting focal cerebral arteriopathy of childhood as etiology. The image showed subacute ischemic areas on the right middle cerebral artery. The pediatricians decided to start pulse corticosteroid therapy and Aspirin. The baby showed a slight improvement of gait. On 11/17/2022 was submitted to a new magnetic resonance Imaging, that showed a chronicity status of the lesions.

Discussion: It is fundamental to consider post-infectious arteriopathy as an etiology of ischemic stroke in the pediatric population. Many pathogens could be associated, but the Varicella-zoster should be considered as an important etiology, because this virus could remain latent in nerve roots for months after the acute infection. The post-varicella arteriopathy may compromise the middle cerebral artery or the internal carotid artery territory, manifesting as an arterial ischemic stroke.

Final Comments: Varicella is a prevalent viral infection in childhood and the varicella-zoster virus remains latent in nerve roots. Considering this and that focal arteriopathy may occur up to one year after the primo infection, we consider this case as relevant.

Publication History

Article published online:
12 May 2025