Acute hemiplegia developed seven weeks to four months after varicella infection in four children reported from the Division of Child Neurology, Institute of Neurological Sciences, Tottori University School of Medicine, Yonago, Japan. Carotid angiography demonstrated segmental narrowing and occlusion of the middle cerebral artery in two patients, findings that were similar to those associated with hemiplegia after herpes zoster ophthalmicus. Cerebral angiitis was cited as the cause. A survey of infectious diseases in the San-in District of Japan showed 26,000 varicella patients and a frequency of varicella with delayed hemiplegia of 1:6500. [1]

COMMENT. The neurological complications of varicella may be caused by viremia with encephalitis, post exanthematous encephalitis or cerebral angiitis. Cerebellar ataxia is the most frequent neurologic complication and hemiparesis is unusual. Of the four children reported with delayed hemiparesis, two recovered completely and two had residual weakness, clumsiness, or dystonia.