ZIKA vasculitis: A new cause of stroke in children?
Anne Landais1, Audrey Césaire2, Manuel Fernandez3
1Neurology Department, University Hospital of Pointe-à-Pitre, Guadeloupe, France.
Insights
Zika virus infection can cause stroke in children, a rare but serious complication. This case highlights the potential link between Zika virus and ischemic stroke in young children, emphasizing the need for further research.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Viral infectious vasculitis is a known cause of stroke in children.
- Zika virus (ZIKV) infection is typically asymptomatic but can lead to neurological complications.
- Neurological manifestations include Guillain-Barré syndrome, ADEM, meningoencephalitis, myelitis, and fetal microcephaly.
Observation:
- A 10-month-old boy presented with fever, rash, conjunctivitis, and subsequent right hemiparesis.
- Brain MRI revealed an ischemic stroke in the left middle cerebral artery (MCA) territory.
- Zika virus was detected in the patient's serum via real-time reverse PCR.
Findings:
- This case represents the first reported instance of cerebral infarction directly associated with Zika virus infection.
- While rare, cerebral infarcts have been linked to dengue virus-induced vasculitis.
- Recent studies indicate Zika virus tropism for endothelial cells, suggesting a potential mechanism for cerebrovascular events.
Implications:
- The findings suggest that Zika virus may play a role in causing stroke, particularly in young children.
- This underscores the importance of considering Zika virus infection in the differential diagnosis of stroke in pediatric patients, especially in endemic areas.
- Further research is warranted to elucidate the pathogenesis of ZIKV-associated vasculitis and stroke.
Abstract:
Viral infectious vasculitis is a cause of stroke in children. Zika virus infection is often asymptomatic. Neurological complications have however been reported: Guillain-Barré, ADEM, meningoencephalitis, myelitis, microcephaly in the fetus of infected mothers. We discuss the case of a child presenting acute infection with ZIKV that was associated with a stroke. A 10-months-old boy without medical history presented after 2days of fever and cutaneous rash, conjunctivitis on day 5, a right hemiparesis on day 6. Brain MRI found an ischemic stroke in the left superficial MCA territory with distal occlusion of left M1 portion of the MCA. Specific real-time reverse PCR detected Zika virus in serum. There are no known cases of cerebral infarction associated with Zika infection. However, cases of cerebral infarcts associated with dengue vasculitis have rarely been described. It has been recently showed that there is a tropism of the Zika virus for endothelial cells. This could be responsible for stroke, possibly particularly in young children.
