Bilateral medial medullary infarction due to varicella-zoster virus vasculopathy: A case report

Bilateral medial medullary infarction (MMI) is a rare form of ischemic stroke, mainly caused by vertebral artery atherosclerosis or small penetrating artery disease. We report a case of bilateral MMI due to varicella-zoster virus (VZV) vasculopathy. An 81-year-old man presented with altered consciousness and right hemiplegia during disseminated herpes zoster. Polymerase chain reaction analysis of his cerebrospinal fluid detected positive VZV-DNA, and magnetic resonance imaging revealed ischemic infarction localized to the ventral part of the bilateral medial medulla and enhancement of the left vertebral artery. After initiating intravenous acyclovir administration, his consciousness, skin rashes, and general condition improved gradually, whereas pyramidal symptoms deteriorated into quadriplegia. This case demonstrates that VZV vasculopathy may cause bilateral MMI.