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Post-varicella arterial ischemic stroke in children and neurocognitive performance: a 4-year follow-up study
Rodrigues, Regina Maria; Farhat, Sylvia Costa Lima; Lucato, Leandro Tavares; Sakano, Tania Miyuki Shimoda; Plaggert, Paulo Scatulin Gerritsen; Casella, Erasmo Barbante; Paz, José Albino da; Schvartsman, Cláudio.
  • Rodrigues, Regina Maria; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Farhat, Sylvia Costa Lima; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Lucato, Leandro Tavares; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Sakano, Tania Miyuki Shimoda; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Plaggert, Paulo Scatulin Gerritsen; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Casella, Erasmo Barbante; Hospital Israelita Albert Einstein. São Paulo. BR
  • Paz, José Albino da; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. São Paulo. BR
  • Schvartsman, Cláudio; Hospital Israelita Albert Einstein. São Paulo. BR
Einstein (Säo Paulo) ; 20: eAO6360, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1375349
ABSTRACT
ABSTRACT Objective To analyze data from children who were previously healthy and presented with post-varicella arterial ischemic stroke upon arrival when admitted to the emergency room, with focus on the clinical/laboratory aspects, and neurocognitive performance after four-year follow-up. Methods Seven children presenting with arterial ischemic stroke after varicella were evaluated at pediatric emergency services in the city of São Paulo (SP), Brazil. Ischemic stroke was determined by magnetic resonance imaging/magnetic resonance angiography in a topography compatible with the areas supplied by the middle cerebral or internal carotid arteries. IgG-class antibodies against varicella zoster virus and varicella-zoster virus DNA by polymerase chain reaction in cerebrospinal fluid were tested. Patients with prothrombotic conditions were excluded. The Pediatric Stroke Outcome Measure was applied upon admission and 4-years after the stroke. Results All patients (age range 1.3 to 4 years) included presented chickenpox 5.1 (±3.5) months before. All patients had analysis of anti-varicella-zoster-virus-IgG in cerebrospinal fluid, but only three (43%) had a positive result. Of the patients 43% had no vascular lesions identified in magnetic resonance angiography. All patients showed improvement in their sequela scores. After 4 years, five patients displayed good evolution in the Pediatric Stroke Outcome Measure, and only one patient presented with a score of 2 in the sensorimotor and cognition areas. No recurrence of arterial ischemic stroke was observed. Conclusion We reinforced the non-progressive course of post-varicella arterial ischemic stroke after 4-year follow-up. The presence of varicella-zoster-virus-DNA detected by polymerase chain reaction, and/or intrathecal IgG antibody against varicella zoster virus, and angiopathy location in magnetic resonance angiography were not determining for the diagnosis. Invasive tests, with low sensitivity, should be well considered in the diagnosis of post-varicella arterial ischemic stroke.


Full text: Available Index: LILACS (Americas) Type of study: Observational study / Prognostic study Language: English Journal: Einstein (Säo Paulo) Journal subject: Medicine Year: 2022 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital Israelita Albert Einstein/BR / Universidade de São Paulo/BR

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Full text: Available Index: LILACS (Americas) Type of study: Observational study / Prognostic study Language: English Journal: Einstein (Säo Paulo) Journal subject: Medicine Year: 2022 Type: Article Affiliation country: Brazil Institution/Affiliation country: Hospital Israelita Albert Einstein/BR / Universidade de São Paulo/BR