Association of acute retinal necrosis with ischemic stroke

Osszefoglalo. A varicella zoster virus (VZV-) fertőzes tipusos első megjelenese a baranyhimlő, kesőbb a reaktivacio soran a herpes zoster. Szemeszeti tunet az V/I-es agyideget erintő zoster eseten gyakori. A legrettegettebb szemeszeti manifesztacio az akut retinanekrozis, mely fulminans lefolyasu, es sulyos szoveti destrukciot, valamint jelentős funkcionalis karosodast, gyakran vaksagot hagy maga utan. Kozponti idegrendszeri vascularis erintettseg előfordulhat baranyhimlőhoz tarsuloan vagy a kesőbbi reaktivaciok soran is, sulyos kovetkezmenyekhez vezetve. A Semmelweis Egyetem Szemeszeti Klinikajan akut retinanekrozis tunetevel erkező 65 eves ferfi esetet ismertetjuk. Az Amerikai Szemorvostarsasag (AAO) diagnosztikus kriteriumainak mindenben megfelelő klinikai kep alapjan azonnal inditott adekvat dozisu antiviralis kezeles mellett 3 nap mulva, contralateralis hemiparesis hattereben, a kepalkoto vizsgalat ipsilateralis ischaemias stroke-ot igazolt. Intraocularis mintabol PCR-vizsgalat bizonyitotta a virus jelenletet. Liquormintaban enyhe anti-VZV-IgA-pozitivitas mutatkozott. Az aktualis szemeszeti betegseg es a stroke tarsulasanak hattereben az eszlelt parameterek, valamint a relevans irodalmi adatok alapjan a varicella zoster virus okozta vasculopathiat valoszinűsitettuk. Gyermekkorban ez az ischaemias stroke leggyakoribb oka, felnőttkorban pedig az V/I-es agyideg herpeses erintettsege eseten negy es felszeres a kockazat stroke kialakulasara. A VZV-reaktivacio okozta akut retinanekrozis es a stroke tarsulasanak lehetősege, bar ismert a nemzetkozi irodalomban, magyar szakirodalom tudomasunk szerint eddig nem targyalta, ez kiemeli esetunk kozlesenek jelentőseget. Orv Hetil. 2021; 162(48): 1940-1945. Summary. The typical first onset of varicella zoster virus (VZV) infection is chickenpox, later herpes zoster during reactivation. Ophthalmic symptoms are common in herpes zoster affecting the V/I cranial nerve. The most dreaded ophthalmic manifestation is acute retinal necrosis, which has a fulminant course and leaves severe tissue damage as well as significant functional impairment, often blindness. Vascular involvement in the central nervous system may occur in association with chickenpox or during subsequent reactivations leading to severe consequences. We report the case of a 65-year-old male patient with symptoms of acute retinal necrosis at the Department of Ophthalmology, Semmelweis University. The clinical picture fulfilled the diagnostic criteria of the American Academy of Ophthalmology (AAO) and after 3 days of the immediately initiated adequate therapy, contralateral hemiparesis appeared, that was confirmed as an ipsilateral stroke by imaging study. The PCR analysis of an intraocular sample confirmed the presence of VZV. Mild anti-VZV IgA positivity was observed in the cerebrospinal fluid sample. Based on the current ophthalmic disease, the associated stroke alongside with the relevant literature data, varicella zoster vasculopathy was probable. VZV vasculopathy is the most common cause of ischemic stroke in childhood and in adulthood herpetic involvement of the V/I cranial nerve elevates 4.5 times the risk of stroke formation. Though the possible association of acute retinal necrosis and stroke caused by VZV reactivation is known in the international literature, to the best of our knowledge it has not been discussed in Hungary so far, which highlights the importance of reporting our case. Orv Hetil. 2021; 162(48): 1940-1945.