Varicella Zoster Virus Vasculitis and Adult Cerebrovascular Disease

Ekaterina Bakradze, Kathryn F. Kirchoff, Daniel Antoniello, Mellanie V. Springer, Peter C. Mabie, Charles C. Esenwa, Daniel L. Labovitz, Ava L. Liberman

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


The role of Varicella zoster virus (VZV) in neurological illness, particularly cerebrovascular disease, has been increasingly recognized. Primary infection by VZV causes varicella (chickenpox), after which the virus remains latent in neuronal ganglia. Later, during aging or immunosuppression, the virus can reactivate causing zoster (shingles). Virus reactivation can also spread to cerebral arteries causing vasculitis and stroke. Zoster is a recognized risk factor for stroke, but stroke can occur without preceding zoster rash. The diagnosis of VZV cerebral vasculitis is established by abnormal brain imaging and confirmed by presence of viral DNA or anti-VZV antibodies in cerebrospinal fluid. Treatment with acyclovir with or without prednisone is usually recommended. VZV vasculitis is a unique and uncommon stroke mechanism that has been under recognized. Careful diagnostic investigation may be warranted in a subgroup of patients with ischemic stroke to detect VZV vasculitis and initiate appropriate therapy. In the following review, we detail the clinical presentation of VZV vasculitis, diagnostic challenges in VZV detection, and suggest the ways to enhance recognition and treatment of this uncommon disease.

Original languageEnglish (US)
Pages (from-to)203-208
Number of pages6
Issue number4
StatePublished - Oct 1 2019


  • Varicella zoster virus
  • central nervous system
  • ischemic stroke
  • vasculitis

ASJC Scopus subject areas

  • Clinical Neurology


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