Dados do Trabalho
POST-VARICELLA ARTERIAL ISCHEMIC STROKE IN CHILDREN: A CASE REPORT
Apresentação do caso
Male patient, one year and eight months old, healthy, with a past 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 with 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. It was made a panel for meningitis and encephalitis, with negative results. Anticorps Anti-Herpes simplex virus were 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 slight improvement of gait. On 11/17/2022 was submitted to a new magnetic resonance Imaging, that showed a chronicity status of the lesions.
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.
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 till one year after the primo-infection, we consider this case as relevant.
Referências (se houver)
1. Rodrigues RM, Farhat SCL, Lucato LT, Sakano TMS, Plaggert PSG, Casella EB, Paz JAD, Schvartsman C. Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study. Einstein (Sao Paulo). 2022 May 6;20:eAO6360. doi: 10.31744/einstein_journal/2022AO6360. PMID: 35544890; PMCID: PMC9070992.
2. Rafay MF, Shapiro KA, Surmava AM, deVeber GA, Kirton A, Fullerton HJ, Amlie-Lefond C, Weschke B, Dlamini N, Carpenter JL, Mackay MT, Rivkin M, Linds A, Bernard TJ; International Pediatric Stroke Study (IPSS) Group. Spectrum of cerebral arteriopathies in children with arterial ischemic stroke. Neurology. 2020 Jun 9;94(23):e2479-e2490. doi: 10.1212/WNL.0000000000009557. Epub 2020 May 26. PMID: 32457211; PMCID: PMC7455362.
3. Helmuth IG, Mølbak K, Uldall PV, Poulsen A. Post-varicella Arterial Ischemic Stroke in Denmark 2010 to 2016. Pediatr Neurol. 2018 Mar;80:42-50. doi: 10.1016/j.pediatrneurol.2017.11.018. Epub 2017 Dec 1. PMID: 29307566.
Stroke, Varicella Zoster Virus Infection, Infant
Fonte de Fomento (se houver)
Declaração de conflito de interesses de TODOS os autores
Sem conflito de interesses.
Doenças cerebrovasculares e terapia intensiva em neurologia infantil
COMPLEXO HOSPITALAR DA UNIVERSIDADE FEDERAL DO CEARÁ - Ceará - Brasil
ANNA JAMYLLE DIAS BORGES LEAL, REBECA MONTALVERNE BARRETO DE PAULA PESSOA, KATHIANE MOREIRA DE FREITAS MARTINS, GABRIELLE GOMES DE SOUSA, FERNANDA PAIVA PEREIRA HONÓRIO