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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).
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.
Acknowledgments
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
Footnotes
Competing interests: None.