The infection may affect large or small arteries where it can cause a vasculitis. In large arteries a granulomatous arteritis may occur.
An infected artery may develop:
(1) arterial aneurysms
(2) arterial stenosis, which may be focal or segmental
The patient may be immunocompetent or immunocompromised. In the immunocompetent patient the infection may remain localized to the cerebral arteries. In the immuncompromised patient the infection may extend into the cerebral parenchyma.
Clinical findings may include:
(1) stroke
(2) seizures
(3) headaches
(4) altered mental status
(5) focal neurological deficits
Diagnosis may involve by demonstrating the virus in the CNS by:
(1) viral culture
(2) serologic response
(3) molecular demonstration of the virus in the CSF (PCR, other)
Magnetic resonance arteriography can identify the extent and severity of the involvement.
The diagnosis can be confirmed by clinical improvement following aggressive anti-VZ therapy including intravenous acyclovir.
