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academies
Volume 2
June 11-13, 2018 | London, UK
Neurology and Neuroscience
6
th
International Conference on
Shingles, an unusual cause of stroke
Kerry Badger, Ruth A Mizoguchi
and
Vongai Mugadza
Chelsea & Westminster NHS Foundation Trust, UK
V
ZV (Varicella Zoster Virus) infection in humans is a
well-documented entity that is linked to numerous
neurological complications, including intraceberal vasculitis.
This can lead to ischaemic or haemorrhagic stroke and is a
major cause of morbidity and mortality. This complication
is more common in immunocompromised or elderly
individuals. We present a case of haemorrhagic stroke
presenting in an individual with recent onset VZV reactivation.
An 83-year-old woman, who was previously living independently,
presented to hospital with an acute onset of delirium and
expressive dysphasia. This presentation was on the background of
a 3 weeks history of an evolving vesicular rash in the dermatomal
distribution of the ophthalmic branch of trigeminal nerve,
characteristicofherpeszosteropthalmicus.Thepatientwasstarted
on oral acyclovir 3 days prior to admission and initial diagnosis
of delirium secondary to herpes zoster infection was made.
On admission, she scored 4 /10 on the abbreviated mental
test score (AMTS), had a positive Hutchinson’s sign and an
unremarkable neurological examination. Laboratory testing
showed raised inflammatory markers. Subsequent CT and MR
brain imaging revealed a right temporal lobe haemorrhage with
interventricular extension. Further imaging of the CT angiogram
showed widespread vessel narrowing, consistent with vasculitis
or a differential diagnosis of widespread atheromatous disease.
Cerebral spinal fluid (CSF) polymerase chain reaction (PCR) was
positive for VZV and further vasculitic screening including ANA and
ANCAwas negative. Adiagnosis of haemorrhagic stroke secondary
to varicella zoster vasculitis was made and the patient was treated
with high dose intravenous methylprednisolone and acyclovir.
It is important to consider viral induced cerebral vasculitis
in susceptible patient groups as a cause of stroke. Correctly
identifying patients presenting with this complication
allows treatment with steroids and anti-viral agents that
have been found to increase chances of a better prognosis.
Speaker Biography
Kerry Badger is a Foundation Doctor currently working at Chelsea and Westminster
Hospital NHS Foundation Trust. She achieved a Bachelor of Medical Sciences in
2015 and a Bachelor of Medicine and Surgery in 2017, both from the University of
Nottingham. She has a developing interest in neurology and has recently completed a
rotation on a combined stroke, neurology and geriatric ward.
e:
badgerkerry@gmail.com