Chickenpox and stroke in children: case studies and literature review

Reis, Ana Filipa; Pais‐Roldán, Patricia; Monteiro, José Paulo

doi:10.1111/apa.12535

Cited by 10 publications

(16 citation statements)

References 15 publications

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“…Several studies and case series suggest that varicella triggers strokes in children[1, 5]. However, we found no evidence in this ecologic analysis that rates of pediatric strokes have changed among children 0–17 years of age during our study interval to parallel the large declines in rates of varicella that we observed.…”

Section: Discussioncontrasting

confidence: 76%

“…While generally self-limited, it was responsible for significant morbidity and mortality due to serious secondary bacterial infections, pneumonia, cerebellar ataxia, transverse myelitis, encephalitis, Reye Syndrome, myocarditis, hepatitis, and hemorrhagic complications[1]. Strokes have also been putatively linked to acute varicella[1–5]. …”

Section: Introductionmentioning

confidence: 99%

“…We now update these analyses with an additional 10 years of data to describe the impact of high, stable levels of first-dose coverage among pre-school children and rapidly-increasing levels of second-dose coverage on the epidemiology of varicella and related outcomes. We also investigated whether rates of pediatric strokes have been affected by order-of-magnitude declines in varicella rates in order to explore hypothesized associations between varicella infection and increased risk of pediatric stroke[1–5] .…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Maturing Varicella Vaccination Program on Varicella and Related Outcomes in the United States: 1994–2012

Leung

Harpaz

2015

J Ped Infect Dis

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Background Although the 1-dose varicella vaccination program, introduced in 1996, has led to significant declines in varicella disease, outbreaks continued to occur which led to the adoption of a 2-dose vaccination program in 2007. We previously reported an 88% decline in varicella-related hospitalizations and 59% decline in outpatient visits during 1994–2002. We now update data on varicella health care utilization with 10 years of additional data, during a period of stabilizing first-dose coverage and rapidly-increasing second dose coverage. Methods We performed a retrospective cohort study using claims data from 1994–2012 Truven Health MarketScan® databases. We examined trends in rates of varicella-related outpatient visits and hospitalizations for MarketScan enrollees aged 0–49 years, including outpatient laboratory testing, outpatient antiviral use and pediatric strokes, with 1994–1995 as the pre-vaccination period and 2006–2012 as the 2-dose varicella vaccination period. Results Varicella outpatient visits declined 84% in 2012 versus the pre-vaccination period, with a 60% decline during the 2-dose period. Varicella hospitalizations declined 93% in 2012 versus the pre-vaccination period, with a 38% decline during the 2-dose period. The proportion of those with a varicella outpatient visit having varicella laboratory testing increased from 6% in 2003 to 17% in 2012. There were 21,445 (17%) with a claim for antivirals, which was relatively stable over time. There was no reduction in pediatric strokes during 1994–2012. Conclusion We document from our large study population that the varicella vaccination program has led to significant declines in outpatient visits and hospitalizations from the pre-vaccination period through 2012, with additional declines during the 2-dose varicella vaccination period.

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Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of the Maturing Varicella Vaccination Program on Varicella and Related Outcomes in the United States: 1994–2012

Leung

Harpaz

2015

J Ped Infect Dis

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“…Other pathogenetic hypotheses include the following: Hematologic spread of VZV; a postinfection vascular immune-mediated reaction; sympathetic activation due to local irritation caused by infection in the superior cervical ganglion; VZV-linked thrombotic vascular occlusion for direct endothelial damage; an acquired transient deficiency of proteins S/C. [ 4 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 3 ] Another complication is postvaricella stroke with an incidence of 1/15,000. [ 4 ] The basal ganglia are the most involved part of the brain in VZV vasculopathy,[ 5 ] where the angiopathy causes transient ischemic attack (TIA) and/or stroke with transient or permanent hemiplegia. The differential diagnosis for VZV vasculopathy includes other diseases that cause hemiplegia, such as trauma, congenital heart disease, vascular malformations, hypercoagulable states, malignancy, congenital errors of metabolism, and infections.…”

Section: Introductionmentioning

confidence: 99%

A case of postvaricella cerebral angiopathy with a good outcome in a child

et al. 2015

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Cerebral vasculopathy is a serious but uncommon complication of varicella-zoster-virus (VZV) infection. Diagnosis is based on a recent history of VZV infection, signs and symptoms of transient ischemic attack or stroke, and vascular anomalies on neuroimaging. We report a case of postvaricella cerebral angiopathy in a 5-year-old child, who was admitted after three episodes of transient right hemiplegia, each one lasting a few minutes. He had contracted chicken pox, the month prior to admission. Brain magnetic resonance imaging showed hyperintense signals in the left lenticular and caudate nuclei, which can be considered to be a result of vasculopathy.

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