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

摘要： 水痘-带状疱疹病毒（varicella-zoster virus，VZV）再激活与缺血性卒中的发生密切相关，其主要机制包括病毒对脑血管直接侵袭导致的内皮损伤、免疫介导的炎症反应及继发性血栓形成等。本文报道1例52岁女性患者，于右侧颈肩部带状疱疹发病10 d后，相继出现后循环及前循环脑缺血症状。影像学检查显示右侧小脑和大脑半球多发梗死，以及同侧颈内动脉、大脑中动脉闭塞，经机械取栓后患者血管部分再通。脑脊液检查显示炎性改变，VZV-DNA呈弱阳性。在排除常见卒中病因后，临床拟诊为VZV相关大血管性脑梗死。本病例报道结合文献回顾，旨在强调临床遇到不明原因或多流域脑梗死时，应重视带状疱疹病史并警惕VZV相关脑血管病变，以增强对该类卒中的识别与综合管理能力。

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