Varicella-Zoster Virus Vasculopathy with Extension from the Cranial Nerves to the Brainstem: A Case Report

Varicella-zoster virus (VZV) infection of the central nervous system can cause vasculopathy, although its mechanisms remain poorly understood. A 72-year-old immunocompetent man developed facial vesicles, headache, fever, and left seventh and eighth cranial nerve palsy. Magnetic resonance imaging revealed swelling of the affected nerves and mixed ischemic-hemorrhagic lesions in the left middle cerebellar peduncle, consistent with VZV vasculopathy. He improved with antiviral and corticosteroid therapy. This case highlights an atypical radiological pattern suggesting an extension from the cranial nerves. VZV vasculopathy should be considered when parenchymal ischemic-hemorrhagic lesions occur after infection, even in the absence of typical vascular distribution.