Objective: Stroke secondary to vasculopathy in the setting of concurrent herpes zoster ophthalmicus (HZO) is extremely rare and can be a diagnostic dilemma. This has been rarely reported in the literature. Hi-resolution vessel wall imaging can aid in accurate diagnosis of zoster vasculopathy. Follow up imaging can assess treatment response with antiviral agents and corticosteroids.

Background: Diagnosis of varicella zoster vasculopathy can be challenging and if not identified and treated early can lead to significant disability and mortality.

Design/Methods: Report of a single case seen at a tertiary neurology centre. Patient underwent Hi-res vessel wall MR imaging on 3.0T field strength. T1 fat saturated volumetric imaging with contrast was performed using a 512 matrix and sub mm slice thickness. TOF MR angiogram, diffusion weighted MRI and multi-slice CT angiogram was also obtained.

Results: A 62-year-old man presented with 2 days history of left hemiparesis. This was on a background of right HZO diagnosed 6 weeks prior and treated with topical antiviral and steroids. On presentation, CT brain revealed right basal ganglia infarct and CT angiogram showed right middle cerebral artery irregularity. Hi-res vessel wall MRI confirmed vasculitis with marked enhancement of right MCA and PCA corresponding to the side of HZO. Lumbar puncture showed raised protein level, mononuclear pleocytosis, and positive polymerase chain reaction study for VZV. Treatment with intravenous acyclovir and a tapering course of corticosteroids was commenced which resulted in improvement of enhancement and beading changes on MRA and CTA. There was also clinical improvement with the treatment and patient was discharged to the rehabilitation unit.

Conclusions: VZV vasculopathy should be considered as a possible stroke aetiology in an appropriate clinical setting. Early diagnosis and treatment can lead to significant improvement in outcome. Hi-res vessel wall MR imaging is crucial for early diagnosis and assessing treatment response.

Disclosure: Dr. Khalilidehkordi has nothing to disclose. Dr. Bailey has nothing to disclose. Dr. Bhuta has nothing to disclose. Dr. Foat has nothing to disclose. Dr. Singh has nothing to disclose. Dr. Sabet has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with CSL, Novartis. Dr. Sabet holds stock and/or stock options in CSL which sponsored research in which Dr. Sabet was involved as an investigator.