关键词: 水痘-带状疱疹病毒; 带状疱疹; 缺血性卒中; 血管炎; 发病机制

Abstract: Varicella-zoster virus (VZV) reactivation is closely associated with ischemic stroke. Its main mechanisms include direct viral invasion of cerebral blood vessels leading to endothelial injury, immune-mediated inflammatory responses, and secondary thrombosis. This article reports a 52-year-old female patient who developed cerebral ischemic symptoms in both posterior circulation and anterior circulation 10 days after the onset of right-sided cervical-shoulder herpes zoster. Imaging examinations revealed multiple infarcts in the right cerebellum and cerebral hemisphere, along with occlusion of the ipsilateral internal carotid artery and middle cerebral artery, which achieved partial recanalization after mechanical thrombectomy. Cerebrospinal fluid analysis demonstrated inflammatory changes and weakly positive VZV-DNA. After excluding common etiologies of stroke, a suspected diagnosis of VZV-related large-vessel cerebral infarction was considered. This case report, combined with relevant literature, aims to emphasize that when encountering unexplained or multi-territory cerebral infarction, clinicians should pay attention to the history of herpes zoster and be alert to VZV-related cerebrovascular disease, thereby enhancing the recognition and comprehensive management of such strokes.

Key words: Varicella-zoster virus; Herpes zoster; Ischemic stroke; Vasculitis; Pathogenesis