Two Patients with Unusual Forms of Varicella–Zoster Virus Vasculopathy

Abstract

Infection of cerebral arteries by varicella–zoster virus (VZV) can produce unifocal or multifocal vasculopathy. Unifocal large-vessel vasculopathy (granulomatous arteritis) usually affects elderly immunocompetent persons, whereas multifocal vasculopathy occurs primarily in persons who are immunocompromised.¹ Unifocal large-vessel infarcts may follow zoster in a trigeminal distribution and are presumed to result from transaxonal transport of virus from trigeminal afferent fibers that innervate vessels of the anterior circulation.² Similarly, smaller infarcts in deep white and gray matter may reflect transport of VZV from trigeminal or cervical afferent fibers to smaller branches of vessels of the posterior circulation.^2,3 We encountered two patients with unusual forms of VZV vasculopathy. Detection of VZV antibody in cerebrospinal fluid and reduced ratios of the concentration of anti-VZV IgG in serum to that in cerebrospinal fluid, in conjunction with normally high ratios for total IgG and albumin, verified the viral cause of their vascular disease.