Dr. Ali Hammed

Tishreen University Hospital, Syria

Title: Cerebral Sinus Venous Thrombosis as a Rare Complication of Primary Varicella Zoster Virus Infection in a child



Chickenpox (Varicella) is a benign illness caused by varicella-zoster virus, predominant in childhood. Chicken pox related Neurological complications are seen in less than 1% cases of chickenpox. Venous thrombosis due to primary (VZV) infection is very rare, and it may occurs secondary to primary or re-activation the virus. We report a case of 5-year-old female complained of ataxia, vomiting, headache, and drowsiness 7 days after the onset varicella zoster infection. She had vesicular lesions with scab over the trunk and limbs. Neurological examination revealed left hemiparesis. Her blood counts and metabolic parameters were normal. Computed Tomography brain showed Hemorrhagic infarct in the left Temporo-parietal region. Coagulation profile was normal. Magnetic Resonance Imaging(MRI) brain revealed Hemorrhagic infarct in the same region. Magnetic resonance Venogram showed thrombosis of left transverse sinus and sigmoid sinus and internal jugular vein. Coagulation profile was normal. VZV- IgG antibody was positive but CSF VZV PCR (Polymerase chain reaction) was found to be negative. Hence CSVT secondary to primary VZV was diagnosed, intravenous acyclovir for 15 days, and low-molecular-weight heparin for 3 days overlapped with oral Warfarin for 3months. After 3 months follow up, the patient experienced a complete recovery. MRI repeated after 3 months showed recanalization of the sinuses. The mechanisms underlying vasculopathy could be vasculitis, thrombosis due to direct endothelial damage, and acquired protein – S deficiency. VZV travels transaxonally to the adventitia of arteries where infection is established followed by transmural migration of the virus to media and intima, pathological vascular remodeling, and stroke. The pathogenic link of occurrence of CSVT after VZV infection is unclear, but some articles showed that it is related to direct endothelial damage by the virus. Although cerebral venous sinus thrombosis is a rare complication of VZV infection, it should be kept in mind and prompt early treatment to prevent catastrophic complications.


Dr. Ali studied General medicine at the Tishreen University, Latakia and graduated as MD in 2018. He then joined the residency program at the Tishreen university hospital. He is researcher and research program leader at TUH. He is reviewer at. Elsevier, BMC, Frontiers, Journal of oncology and Medicine. To his credit, he has published 9 articles in various international peer reviewed journals.

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