Ayman Mahmoud Alboudi
Rashid Hospital, UAE
Ayman Alboudi has done MD at Tishreen university Syria, then had masters of neurology from Damascus University . He is currently working as specialist neurologist at Rashid hospital in Dubai – UAE. He Has 4 abstracts already accepted in the next world stroke conference in Istanbul, one case report submitted to BMJ, and contributing as investigator in 2 phase 3 trail in MS treatment .Ongoing as principle investigator in 2 prospective studies on cognitive impairment in MS patients.
Background: Cerebral venous thrombosis is a rare disorder and the annual incidence around 1/100000. There are many risk factors for CVST. Heller et al found in his study on CVST in children that the majority of cases are multifactorial, as a combination of prothrombotic risk factors and/or underlying condition such as infection even more CVST can be precipitated by systemic infection. However CVST associated with VZV infection is a rare entity, 4 case reports in the literature have been encountered. But notably there was no single case of CVST of multifactorial origin, precipitated by systemic VZV infection. This case report is reported as it is the first in theliterature.
Case report:31y old male, previously healthy with no past medical history; presented with a history of skin rash started 14d ago, accompanied with low grade fever at the first few days, with progression consistent with VZV. 5d ago he started to have headache, holocephalic, accompanied with nausea and vomiting. On the day ofadmission he had 2 GTCS. The neurological exam was totally normal apart from mild bilateral pupil edema. General examination showed skin rash in crusting stage. There was no fever or meningitis sign. CT brain was done and showed small haemorrhagic infarction on the left occipital area, CT venogram showed CVST on the left transverse, lateral sinuses and superior sinus.Blood tests showed positive IgG, IgMAb for VZV, also positive antinuclear, phosphatidylserin, anticardiolipin antibodies, B2 microglobulin. Other investigations as Anti dsDNA, HCV ab, HBV ag, ANCA p,c all were negative.LP was not done as the patient refused.The patient was treated with acyclovir, hydration and phenytoin; and he improved gradually. There was no seizure and the headache relieved.
Discussion:VZV is a commonly seen infection as febrile illness with a vesicular rash, especially in pediatric population. However, the neurological complications in adults specifically, are not commonly encountered, but include arterial vasculopathy, which can cause ischemic strokes, aneurysms, subarachnoid or cerebral hemorrhages, and cortical dissection. Our patient was like Saddiqi et al patients, without any signs of purpurafulminan, but he was unique in the fact that he has positive antinuclear, phosphatidylserin, anticardiolipin antibodies, B2 microglobulin, and VZV IgG, IgM (which were negative in Saddiqi patients).One of the cases of saddiqi patients had low protein S, C at presentation, but was not repeated later to confirm the diagnosis, as those 2 proteins can be low in acute thrombosis, acute infection. And according to this fact those disturbance are not known to be a cause or a result.This case highlighted VZV as precipitating factor for CVST in patients with predisposing factors, which can be the notifying to the primary disturbance which will require permanent anticoagulation for life.
Speaker PPTsDownload PPT