Neuropediatrics 2024; 55(S 01): S1-S25
DOI: 10.1055/s-0044-1791892
Durchblutungsstörungen des ZNS

Stroke and Varicella Infection: A Pilot Study

D. Brechbühl
1   Division of Neuropaediatrics, Development and Rehabilitation, Children’s University Hospital, University of Bern, Bern, Switzerland
,
R. Münger
1   Division of Neuropaediatrics, Development and Rehabilitation, Children’s University Hospital, University of Bern, Bern, Switzerland
,
D. Grandgirard
2   Institute for Infectious Diseases, University of Bern, Bern, Switzerland
,
S. L. Leib
2   Institute for Infectious Diseases, University of Bern, Bern, Switzerland
,
F. Romano
3   Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, Bern, Switzerland
,
N. Slavova
4   University Hospital for Neurology, Inselspital Bern, Bern, Switzerland
,
M. Steinlin
1   Division of Neuropaediatrics, Development and Rehabilitation, Children’s University Hospital, University of Bern, Bern, Switzerland
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    Background/Purpose: A subset of pediatric acute ischemic stroke (AIS) can be linked to varicella zoster virus (VZV) infections. This research aims to assess the feasibility of a larger prospective cohort study to investigate the mechanisms favoring VZV-associated AIS development.

    Methods: This prospective cohort feasibility study included children aged 3 to 11 with VZV infection. Blood samples were taken during the acute phase and 6 to 8 weeks later, with a cerebral MRI at the second visit. In addition to collecting various feasibility outcome measures, we assessed inflammatory plasma biomarkers, including matrix metalloproteinases (MMPs) and their endogenous inhibitors (TIMPs), and compared these with data from a previous VZV-associated AIS cohort.

    Results: Over a period of 25 months, 8 out of 77 children screened were included. The main reason for decline was the study’s perceived invasiveness.

    MMP-9 was significantly higher in the chronic phase of VZV infection than in acute phase and the control group. TIMP-1 and TIMP-4 were significantly higher both in the acute and chronic phase of VZV infection than in the control group. Additionally, TIMP-4 did not differ significantly between the chronic phase of VZV infection and the VZV-associated AIS group.

    Conclusion: Based on the measured inclusion rate and the estimated 1:10,000 VZV infections leading to AIS, screening of about 83,000 children with VZV would be needed to find one AIS case. TIMP-4 data suggest pathophysiological similarities between chronic VZV infection and VZV-associated AIS, serving as a potential biomarker to identify at-risk children.

    Given that previous data suggest MMP-9 can cause plaque rupture, the increase of MMP-9 in the chronic phase of a VZV infection may partly explain the heightened risk of VZV-associated AIS.

    In view of the potential impairments caused by VZV-associated AIS and the possibility of primary prophylaxis, further research should be envisioned. An adapted design is recommended due to recruitment issues in this study.


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    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    08 October 2024

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