EC Paediatrics

This study reports the case of an 11-year-old child who developed acute ischemic stroke (AIS) following varicella infection. The patient had no significant medical history and initially recovered well from the varicella episode. However, four months later, he presented with sudden right upper limb monoplegia, vomiting, and headaches. Neurological examination revealed motor and sensory deficits in the right upper limb and weakness (3/5) in the left upper limb. Imaging studies, including brain CT and MRI, confirmed a hypodense pontine lesion consistent with AIS. Laboratory tests indicated an inflammatory response, and viral serology showed the presence of VZV DNA in the cerebrospinal fluid. Treatment with antivirals and corticosteroids led to significant improvement over three months, with complete recovery after seven months. This case underscores the potential for severe neurological et vascular complications, including AIS, following varicella infection in immunocompetent children. Understanding the pathophysiology and early recognition of such complications are crucial for timely intervention and optimal outcomes.

 Keywords: Acute Ischemic Stroke (AIS); Varicella-Zoster Virus (VZV) Complications; Pediatric Stroke

1. Yo Han Ra., et al. “Enhancement of optic nerve in leukemic patients: leukemic infiltration of optic nerve versus optic neuritis”. Investigative Magnetic Resonance Imaging 20 (2016): 167-174.
2. Theresa Mallick-Searle., et al. “Postherpetic neuralgia: epidemiology: pathophysiology, and pain management pharmacology”. Journal of Multidisciplinary Healthcare 9 (2016): 447-454.
3. S W P Lakmini Daulagala and Faseeha Noordeen. “Epidemiology and factors influencing varicella infections in tropical countries including Sri Lanka”. Virusdisease3 (2018): 277-284.
4. Maria A Nagel and Don Gilden. “Complications of varicella zoster virus reactivation neurologic manifestations of systemic disease”. Current Treatment Options in Neurology4 (2013): 439-453.
5. Hiral Anil Shah., et al. “Global prevalence of varicella-associated complications: a systematic review and meta-analysis”. Infection Diseases and Therapy1 (2024): 79-103.
6. Subhadeep Gupta., et al. “Post-varicella neurological complications: a preliminary observation from a tertiary care centre of eastern India”. Annals of Indian Academy of Neurology 2 (2022): 207-213.
7. Jiunn-Horng Kang., et al. “Increased risk of stroke after a herpes zoster attack: a population-based follow-up study”. Stroke11 (2009): 3443-3448.
8. Jacqui Wise. “Shingles is linked to increased risk of cardiovascular events”. British Medical Journal 351 (2015): h6757.
9. Mitchell S V Elkind., et al. “Infectious burden and risk of stroke: the northern Manhattan study”. Archives of Neurology 1 (2010): 33-38.
10. Maria A Nagel and Don Gilden. “Varicella zoster complications”. Current Treatment Options in Neurology 4 (2013): 439-453.
11. Catherine Amlie-Lefond and Don Gilden. “Varicella zoster virus: a not uncommon cause of stroke in children and adults”. Journal of Stroke and Cerebrovascular Diseases 7 (2016): 1561-1569.