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Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study
Regina Maria Rodrigues1, Sylvia Costa Lima Farhat1, Leandro Tavares Lucato2
1Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Insights
Pediatric arterial ischemic stroke following varicella (chickenpox) generally has a non-progressive course. Four-year follow-up showed good neurocognitive and sensorimotor outcomes in most children, with no stroke recurrence.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Vascular Neurology
Background:
- Arterial ischemic stroke (AIS) can occur in children following varicella (chickenpox).
- Understanding the long-term outcomes and diagnostic markers of post-varicella AIS is crucial for pediatric care.
Purpose of the Study:
- To analyze clinical and laboratory data of children with post-varicella AIS.
- To evaluate neurocognitive performance and outcomes four years after stroke.
- To identify factors influencing the diagnosis and prognosis of post-varicella AIS.
Main Methods:
- Retrospective evaluation of seven children with post-varicella AIS.
- Diagnosis confirmed by MRI/MRA.
- Testing for varicella-zoster virus (VZV) IgG antibodies and VZV DNA in CSF.
- Exclusion of prothrombotic conditions.
- Assessment using the Pediatric Stroke Outcome Measure (PSOM) at admission and 4-year follow-up.
Main Results:
- Patients (1.3-4 years old) had varicella ~5 months prior.
- VZV IgG in CSF was positive in 43%; VZV DNA was not specified.
- 43% had no identified vascular lesions on MRA.
- All patients improved in sequela scores.
- Five of seven showed good PSOM outcomes at 4 years; one had a score of 2 in sensorimotor/cognition.
- No AIS recurrence was observed.
Conclusions:
- Post-varicella AIS demonstrates a non-progressive course over a 4-year follow-up.
- VZV DNA, intrathecal VZV IgG, and MRA findings were not definitive diagnostic determinants.
- Invasive diagnostic tests with low sensitivity require careful consideration in diagnosing post-varicella AIS.
Objective:
To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up.
Methods:
Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke.
Results:
All patients (age range: 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed.
Conclusion:
We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.
