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Varicella Zoster Virus (VZV) Vasculitis

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  • 50-year-old patient presented with visual disturbance and left sided weakness.
  • CSF PCR was positive for VZV.
  • MRI showed multiple left MCA territory infarcts.
  • There wasthick eccentric enhancement on the right MCA but no stenosis initially.
  • After 5 months and following steroid therapy, the enhancement associated with the vasculopathy regressed but a severe long segment stenosis developed. This only slightly improved (trace of flow related signal) on further follow-up MRA (not shown).