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AN ATYPİCAL CASE OF POST VARİCELLA STROKE İN A CHİLD ASSOCİATED WİTH HYPERHOMOCYSTEİNEMİA AND MTHFR A1298C MUTATİON

AN ATYPİCAL CASE OF POST VARİCELLA STROKE İN A CHİLD ASSOCİATED WİTH HYPERHOMOCYSTEİNEMİA AND MTHFR A1298C MUTATİON

INTRODUCTION We present an atypical case of post-varicella stroke in a child associated with hyperhomocysteinemia and MTHFR A1298C mutation.

CASE REPORT A 17-year-old male had was admitted to the pediatric emergency unit with complaints of headache, confusion, dysphasia, and gait disturbance. The patient had a varicella infection one month ago. He had transient vision loss in both eyes ten days after the varicella infection. In his physical examination, his consciousness was confused. He responded to a verbal stimulus and could open his eyes. He had central facial paralysis, dysarthria, hemiparesis on the right side, and muscle strength in the lower and upper extremities of the right side were grade 3/5. There was hyperreflexia in the right upper and lower extremities. The Babinski sign was positive on the right side. Acute ischemic infarct findings were observed in the left thalamus and left occipital lobe in diffusion-weighted MRI. Cerebral MRI angiography showed that the left posterior cerebral artery was of narrow calibration. The patient's homocysteine level was high in blood tests, and he had MTHFR A1298C Homozygous Mutation. The patient considered an acute ischemic stroke secondary to post-varicella vasculitis. The patient had was given antiaggregant and anticoagulant, acyclovir, glucocorticoid treatments. After the treatments, the patient's states of consciousness and clinical findings improved.

CONCLUSION Previously post-varicella acute ischemic stroke in children has been reported. But post-varicella stroke associated with hyperhomocysteinemia has not been reported before.
Keywords: Stroke, Varicella, hyperhomocysteinemia