Stroke in childhood is an uncommon event, but carries a significant long-term morbidity. There is a wide spectrum in terms of etiology and causation is often multifactorial. Varicella-Zoster infection has been recognised as a risk factor for arterial ischemic stroke.
The authors report the case of a 4 year-old girl who presented with sudden onset left hemiparesis with predominant face and arm involvement, with partial resolution after 15 minutes, but recurrences in the 3 following days. She was a previously healthy child, with an unremarkable familial and personal history, except for a varicella rash 4 months before. Magnetic resonance imaging with angio-MRI showed signs of acute ischemia in the deep territory of the right middle cerebral artery (MCA) and narrowing of the right internal carotid artery (ICA), with no signs of dissection. Carotid Doppler located the lesion at the base of the skull with extension of flow disturbance to the proximal segments of anterior (ACA) and MCA. Further diagnostic studies included transthoracic echocardiogram, prothrombotic, metabolic and serologic studies. Cerebral angiography with evaluation of the aortic arch depicted a marked stenosis of the supraclinoid segment of the right ICA with extension to the proximal segments of the ACA and MCA and a faible filling of ipsilateral lenticulostriate arteries.
Once embolic, hematologic and metabolic causes have been excluded, and considering the recent history of varicella infection, post-Varicella arteriopathy remains as the most probable diagnosis. The authors intend to highlight the importance of Varicella-Zoster infection as a risk factor for stroke in childhood.