Cerebrovascular Manifestations of Adult-Onset Varicella Zoster Virus Infection in the Central Nervous System: A Literature Review

Background Cerebrovascular complications after adult-onset varicella-zoster virus (VZV) infection have been increasingly recognized. The aim of this study was to analyze clinical and neuroimaging findings, treatment and outcome of these patients. Methods Systematic literature review from January 2000 to December 2019. Results We analyzed 31 articles with a total of adult-onset 34 cases, including 25 (73.53%) cases of ischemic stroke (median age 52 years), 6 of intracerebral hemorrhage (median age 70.5 years) and 3 with venous sinus thrombosis. The incidence in men was higher than in women in ischemia (72% and 28%) or venous sinus thrombosis groups (100% for men). There was median time with 42.8 days from herpes zoster infection to hospital in patients with ischemic stroke. Cognitive impairment was the most common symptoms either in the ischemic group (56%) or hemorrhagic group (83.33%). The lesions after VZV-associated cerebral infarction or hemorrhage were mutifocal and was most common in the parietal lobe. Venous sinus thrombosis was common in the transverse sinus (100%). Lesions in large vessels (48%) were common, followed by small vessels (36%) in ischemic group and multiple beaded stenosis (16.67%) were showed in hemorrhagic group by digital subtraction angiography or magnetic resonance angiography. 60.87% of the patients with antiviral treatment in the ischemic group had favorable prognosis. All patients with anticoagulant therapy in venous sinus thrombosis group improved well (100%), however, 60% of the patients with intracerebral hemorrhage had a poor prognosis or died. Conclusion We found ischemic stroke related with VZV encephalitis is common and mainly affects the middle-aged. In general, the young patients with venous sinus thrombosis improve completely, however, the old patients with intracerebral hemorrhage have poor prognosis. When the patient represents with some neurological symptoms within 2 months after VZV infection, and multiple lesions probably induced by vasculitis showed in neuroimaging, cerebral complications related with VZV infection should be considered even though the existence of some vascular risk factors for atherosclerosis.