A 17-month-old boy with HZO and delayed contralateral hemiparesis following intrauterine varicella exposure is reported from the Dept of Neurology, Univ Texas Med Sch, Houston, TX. He presented with ataxia and a progressive right-sided weakness. His mother had chicken-pox at 8 months of gestation but he appeared normal at birth. A vesicular rash developed 4 weeks before examination in the distribution of the ophthalmic and mandibular divisions of the left trigeminal nerve. CSF showed mononuclear pleocytosis, CT demonstrated multiple areas of hypodensity in the left basal ganglia, and angiography revealed occlusion of the left lenticulostriate arteries. Treatment with Acyclovir for 10 days was followed by recovery except for minimal right hemiparesis [1]. Passive immunization of susceptible women exposed to varicella is recommended to reduce the risks of maternal and fetal varicella. The determination of varicella zoster virus membrane antigen or equivalent anti-varicella antibody status in pregnant women exposed to varicella is a rapid, satisfactory method for determining who should receive varicella immunoglobulin passive immunization. [2]

COMMENT: The authors cited only one similar previous case in a child, a 7-year-old boy. Delayed focal cerebral angiitis and infarction may occur after an interval of days to months between HZO and neurologic complications in adults. Passive immunization of exposed susceptible women reduces risks of maternal and fetal varicella. [2]