Serial MR angiography and contrast-enhanced MRI in chickenpox-associated stroke

The association between primary varicella infection (chickenpox) and pediatric stroke is being recognized with increasing frequency.1,2⇓ Typically, affected children present with acute hemiplegia, have lacunar strokes on MRI, and have focal intracranial vascular stenosis on direct cerebral angiography.1 In a recent study of transient cerebral arteriopathy,3 evidence for preceding varicella infection was found in several cases, suggesting that varicella-associated intracranial arterial stenosis may be reversible. The utility of noninvasive serial MRI in diagnosing and managing such cases is not known. We report a case of chickenpox-associated stroke in which initial MRI showed focal stenosis and enhancement of the middle cerebral artery (MCA) and serial MR studies showed gradual resolution over months. Four months after uncomplicated chickenpox, a 14-year-old Indian boy experienced three spells of transient right hemiparesis with aphasia and isolated spells of left hemiparesis, diplopia, and right transient monocular blindness, each lasting a few minutes. He was previously healthy and was fully immunized. Neurologic and cardiac examinations were unremarkable, fundi were normal, and there was …