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Abstract Details

Zoster vasculopathy surveillance using intracranial vessel wall imaging
Infectious Disease
S45 - Neuroinfectious Disease: Treatments, Diagnostics, and Outcomes (2:06 PM-2:17 PM)
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Zoster vasculopathy is an uncommon consequence of varicella zoster infection of the skin or eyes. It results in infection of the intracranial blood vessels leading to focal stenosis and subsequent strokes. Although conventional angiography has traditionally been used to identify the large vessel stenoses, intracranial vessel wall imaging (VWI) – commonly referred to as ‘black blood’ sequences – can be used to demonstrate areas of vessel wall enhancement associated with vasculitides as can be found in zoster vasculopathy.

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We present two cases of intracranial zoster vasculopathy with associated vessel wall enhancement that resolved following the administration of acyclovir, even though the antiviral was administered months after the initial cutaneous and ophthalmologic infections. Both patients initially presented with recurrent strokes approximately six months after a zoster infection, and after administration of acyclovir, neither patient experienced any strokes in the subsequent six months.

We propose utilizing VWI to assist in the diagnosis of zoster vasculopathy and to monitor treatment response. Our cases also reinforce the importance of providing a trial of intravenous acyclovir to patients with suspected zoster vasculopathy, as clinical and radiographic improvement can occur even months after the initial infection.

Authors/Disclosures
Ivan D. Carabenciov, MD (Mayo Clinic)
PRESENTER
Dr. Carabenciov has nothing to disclose.
Stephen W. English, MD (Mayo Clinic) Dr. English has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Brainomix.
No disclosure on file
George W. Petty, MD (Mayo Clinic) No disclosure on file
Eugene L. Scharf, MD (Mayo Clinic) The institution of Dr. Scharf has received research support from American Brain Foundation. The institution of Dr. Scharf has received research support from NIH. Dr. Scharf has received personal compensation in the range of $500-$4,999 for serving as a Presenter with Grand Rounds. Dr. Scharf has a non-compensated relationship as a Steering committee with Johnson and Johnson that is relevant to AAN interests or activities.