Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

17 March 2021: Articles

Chronic Headache and Cerebral Venous Sinus Thrombosis Due to Varicella Zoster Virus Infection: A Case Report and Review of the Literature

Unusual clinical course

Laith Alamlih A* , Mohammad Abdulgayoom A , Suresh N. Menik Arachchige A , Mohammed Hamza Shah B , Muhammad Zahid A

DOI: 10.12659/AJCR.927699

Am J Case Rep 2021; 22:e927699

Table 2. Patients with cerebral venous sinus thrombosis complicating varicella zoster primary infection.

Khan 2019 [15]Mehta 2018 [16]Imam 2017 [17]Shrivastava 2016 [23]Paul 2016 [18].2
2620391837
MaleMaleMaleMaleMale
2 weeks prior to presentation2 weeks prior to presentation7 days prior to presentation2 weeks prior to presentation3 weeks prior to presentation
NonNon
No meningeal signNuchal rigiditySlight neck stiffnessNot mentionedNo meningeal signs
Not mentionedNormal on the beginning then developed papilledemaNot mentionedBilateral papilledemaNot mentioned
Dural sinus thrombosis, involving left transverse, sigmoid sinuses, and internal jugular vein (IJV)Extensive cerebral venous sinus thrombosisSuperior sagittal sinus, left transverse and sigmoid sinusesSuperior sagittal, right transverse and sigmoid sinus
Hemorrhage and Brain edemaMRV T2 fluid attenuated inversion recovery (FLAIR) hyperintense area in the left tempo-parieto-occipital area, suggestive of subacute infarct (left MCA and posterior cerebral artery territory) with effacement of cortical sulci seen on the left side, suggestive of edemaNot mentionedCT: Hyper density in Superior sagittal sinus. MRV: Thrombosis of superior sagittal sinus, left transverse and sigmoid sinusesRight frontoparietal venous infarction
NormalCSF was clear and the opening pressure was normal. CSF report showed normal leukocyte count of 5 cells/mm, all lymphocytes with mildly raised CSF protein (62.1 mg/dL) and with normal sugar (79 mg/dl). CSF IgM for VZV was positiveNot mentionedPleocytosis with 40 cells/mm, mildly raised protein 60 mg% and normal glucoseNot mentioned
Positive IgMMentioned to be positiveNot mentionedNot mentionedNot mentioned
Not mentionedNot mentionedNot mentionedNot mentionedNot mentioned
Pulmonary embolismnonoNoRight atrium thrombosis, Pulmonary embolism, left femoral and distal popliteal vein
NoCoagulation profile normal and homocysteine normalNoYesYes
ImprovedComplete recoveryComplete recovery.Complete recoveryHe gradually improved. and day 12 total recovery
Paul 2016 [18].1Gayathri 2016 [19]Sardana 2014 [20]Mathew 2013 [13]
30233033
MaleMaleMaleFemale
3 weeks prior to presentation2 weeks prior to presentation2 weeks prior to presentation16 days prior to presentation.
None
Not mentionedNuchal rigidity (+ve Kernig sign)Nuchal rigidityNot mentioned
Bilateral papilledemaBilateral papilledema.NormalBilateral papilledema
Transverse sinus and sigmoid sinus on the right sideSuperior sagittal, bilateral transverse and right sigmoid sinuses which extends into the straight sinusLeft transverse and sigmoid sinusRight transverse, sigmoid and straight sinuses
Hemorrhagic infarct in the right temporoparietal lobe with edema and mass effectVenous hemorrhagic infarcts were seen in right frontoparietal cerebral parenchyma (largest 4 cm in length) and in right thalamus. Multiple lacunar infarcts in bilateral frontoparietal white matterCT scan showed a hemorrhagic infarct in the left temporo-parietal lobe with edema and mass effect over the ipsilateral lateral ventricle. MRV with gadolinium hemorrhagic infarct with significant perilesional edema and adjacent meningeal enhancement in left tempo-parietal region with mass effect. Venography showed loss of normal signal intensity in transverse sinus and sigmoid sinus on left sideMagnetic resonance imaging and venography revealed thrombosis of right transverse, sigmoid, and straight sinuses without venous infarcts or hemorrhages
Not mentionedPleocytosis with 20 cells/mm, mildly raised protein 60 mg%, and normal glucose (40 mg%).CSF VZV DNA by PCR was positiveCell counts: 3 cells/mm; protein 46 mg%, and glucose 54 mg%Not mentioned
Not mentionedPositive for IgGNot mentioned.Not mentioned
Not mentionedPositive IgG with reduced serum/CSF ratios of VZV IgGPositive IgG Reduced serum/CSF ration of VZV IgGNot mentioned
NoNoNoNo
Low protein sYesYesNo
Iv heparin followed with oral anticoagulation
He gradually improved over 3 weeks.ImprovedHeadache and language function gradually improved over few days. Hemiparesis gradually improved over 4 weeksComplete recovery
Menon 2012 [14]Sada 2012 [21]Siddiqi 2012 [22].2Siddiqi 2012 [22].1
20301520
FemaleMaleMaleMale
Unclear15 days prior Presentation3 weeks prior to presentation1-week prior to presentation
Non
Nuchal rigidityNot mentioned.Not mentioned.No meningeal signs.
NormalBilateral papilledema.Not mentionedNormal
Superior sagittal and right transverse sinusesCentral venous sinus thrombosisCentral venous sinus thrombosis
Hemorrhagic infarct in the left temporal lobe with edema and mass effect over the ipsilateral lateral ventricle.CT: brain showed diffuse cerebral edema and hyper dense superior sagittal and right transverse sinuses. MRV: showed thrombosis of superior sagittal and right transverse sinusesMRI revealed extensive CVST MRA showed focal area of narrowing in the left distal middle cerebral artery just before trifurcation with a relative paucity of the left Sylvian branches, suggesting vasculitisWidespread CVST
Pleocytosis with 40 cells/mm, mildly raised protein 60 mg%, and normal glucoseNot specifically mentionedNormalNormal
Not mentionedPositive IgGNot mentionedNot mentioned
Not mentionedPositive IgG with Reduced serum/CSF ratios of VZV IgGNot mentionedNot mentioned
NoNoNoNo
YesyesYesyes
Total recoveryComplete recoveryComplete recoveryComplete recovery

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923