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Varicella zoster virus and intracranial dolichoectasia in a late adult cancer survivor

C M Dalton¹, H R Jäger², N A Losseff¹, R J Greenwood¹

¹ Acute Stroke and Brain Injury Service, National Hospital for Neurology and Neurosurgery, London, UK
² The Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK

Correspondence to:
catherine.dalton{at}uclh.nhs.uk

A 50-year-old secretary presented with a 23 year history of forgetfulness and left-sided deafness following chemotherapy for Hodgkin’s lymphoma, complicated by disseminated tuberculosis and varicella zoster virus (VZV). MRI revealed carotid and vertebro-basilar dolichoectasia, and multiple small deep infarcts including a left ventral cochlear nucleus infarct resulting in memory impairment and left sensory neural deafness (figs 1, 2).

View this figure (31K): in this window | in a new window | PowerPoint for Teaching   Figure 1 (A) T2 weighted axial MRI showing bilateral terminal carotid artery dolichoectaseia. (B) Left pontine ventral cochlear nucleus infarct.

 

View this figure (44K): in this window | in a new window | PowerPoint for Teaching   Figure 2 Three dimensional time-of-flight angiography showing ectasia of the left vertebral artery, basilar artery, proximal and intracerebral internal carotid arteries, both M1 segments and right A1 segment, and left A1 segment hypoplasia.

 

Intracranial arterial dolichoectasia (IADE) is due to elongation and fusiform dilatation of the intracranial arteries. It is associated with older age, male sex, hypertension and previous history of myocardial infarction, but not with markers of carotid atherosclerosis, and is usually the result of a non-atherosclerotic disorder of the elastic tissue in the arterial wall.¹ Complications include damage to perforating arteries, lacunar infarction, haemorrhage, brainstem and cranial nerve compression, and obstructive hydrocephalus.^{1 2}

IADE also occurs in association with elastic tissue disorders and Fabry’s disease, and also in immunocompromised children with AIDS as a result of VZV angiitis.^{3 4}

An occlusive focal VZV angiitis causing stroke after zoster infection in otherwise normal adults is well recognised,⁴ and an acute disseminated VZV cerebral vasculopathy with multiple aneurysms has been reported in an HIV immunocompromised adult.⁵ However, to our knowledge, IADE has not previously been reported in late adult survivors of cancer, immune suppression and VZV infection.

This article has been adapted from Dalton C M, Jäger H R, Losseff N A, Greenwood R J. Varicella zoster virus and intracranial dolichoectasia in a late adult cancer survivor Journal of Neurology, Neurosurgery and Psychiatry 2008;79:573

Competing interests: None.

1. Pico, F, Labreuche, J, Touboul, PJ, et al. , for the GENIC Investigators. Intracranial arterial dolichoectasia and its relation with atherosclerosis and stroke subtype. Neurology 2003;61:1736–42.[Abstract/Free Full Text]
2. Passero, SG, Calchetti, B, & Bartalini, S. Intracranial bleeding in patients with vertebrobasilar dolichoectasia. Stroke 2005;36:1421–5.[Abstract/Free Full Text]
3. Dubrovsky, T, Curless, R, Scott, G, et al. Cerebral aneurysmal arteriopathy in childhood AIDS. Neurology 1998;51:560–5.[Abstract/Free Full Text]
4. Gilden, DH, Kleinschmidt-DeMasters, BK, LaGuardia, JJ, et al. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med 2000;342:635–45.[Free Full Text]
5. Saraya, T, Shimura, C, Wada, H, et al. Evidence for vascular spread of varicella zoster-associated vasculopathy. Ann Intern Med 2006;144:535–7.[Free Full Text]

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