A Child with Vesicles and Weakness

Arterial ischaemic stroke (AIS) is a rare complication of varicella (‘chickenpox’), a common childhood infection. Affected children are usually young and otherwise well with antecedent varicella in the previous year. Post-varicella arteriopathy is typically monophasic presenting with hemiplegia caused by focal, proximal middle cerebral artery stenosis and basal ganglia infarction. In contrast, VZV vasculitis typically causes multifocal arteriopathy with recurrent, multiple arterial territory cerebral infarction. We report a 9-year-old boy with stuttering onset AIS referred with suspected moyamoya. Unilateral ‘moyamoya type vessels’ were reported on a background of multifocal anterior and posterior circulation arterial stenoses. There was a varicella history four months prior. CSF confirmed a raised VZV IgG index and no further recurrence occurred following a prolonged course of aciclovir and corticosteroids. This case reinforces moyamoya as a radiological description and should be clinically correlated, including consideration of VZV-related AIS where there has been a positive history.