Two Patients with Unusual Forms of Varicella–Zoster Virus Vasculopathy

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Abstract
Infection of cerebral arteries by varicella–zoster virus (VZV) can produce unifocal or multifocal vasculopathy. Unifocal large-vessel vasculopathy (granulomatous arteritis) usually affects elderly immunocompetent persons, whereas multifocal vasculopathy occurs primarily in persons who are immunocompromised.1 Unifocal large-vessel infarcts may follow zoster in a trigeminal distribution and are presumed to result from transaxonal transport of virus from trigeminal afferent fibers that innervate vessels of the anterior circulation.2 Similarly, smaller infarcts in deep white and gray matter may reflect transport of VZV from trigeminal or cervical afferent fibers to smaller branches of vessels of the posterior circulation.2,3 We encountered two patients with unusual forms of VZV vasculopathy. Detection of VZV antibody in cerebrospinal fluid and reduced ratios of the concentration of anti-VZV IgG in serum to that in cerebrospinal fluid, in conjunction with normally high ratios for total IgG and albumin, verified the viral cause of their vascular disease.