Varicella zoster vasculopathy presenting as bilateral subdural haematoma in an infant: case report of a rare case and literature review.

A 6-month-old infant developed persistent neurological and systemic symptoms after chicken pox that were later found to be associated with bilateral subdural collections.

• The infant initially had chicken pox with fever, irritability, and generalized vesicular rash; the rash and fever settled over 2 weeks.
• Irritability, decreased feeding, intermittent vomiting, and regression of developmental milestones persisted after the rash resolved.
• Weight fell progressively from the 50th to the 9th centile.
• At 7 months, evaluation for vomiting and persistent irritability revealed bilateral subdural collections.

The subdural collections resembled those typically seen after non-accidental injury, creating a diagnostic mimic.

• Imaging showed bilateral subdural collections resembling those typically seen following non-accidental injury.
• The authors conclude VZV-related subdural haematoma can mimic findings seen following non-accidental injury.

The subdural collections progressed and recurred despite staged surgical treatment, ultimately requiring a subdural-peritoneal shunt.

• Collections increased over the next 3 weeks and the infant developed a tense fontanelle.
• Ultrasound-guided trans-fontanelle aspiration yielded blood-stained fluid and gave transient improvement.
• Rapid re-accumulation led to bilateral burr-hole evacuation with creation of subdural pockets.
• Further recurrence was finally managed with a right-sided subduro-peritoneal shunt.

Subdural fluid tested positive for VZV IgG, indicating previous VZV CNS encephalitis or vasculitis as the likely cause.

• The authors interpret the VZV IgG positivity in subdural fluid as indicative of previous VZV CNS encephalitis or vasculitis.
• The case is titled as VZV vasculopathy presenting as bilateral subdural haematoma.

The child made a full recovery after treatment.

• On follow-up, the child regained weight and developmental milestones.

Chronic subdural haematoma following VZV infection in children has not previously been reported.

• The authors present this as a rare, delayed, and life-threatening complication of VZV infection in infancy.
• The report is accompanied by a literature review.

Prolonged neurological symptoms after VZV infection should prompt consideration of intracranial complications and prompt investigation.

• The authors state prolonged symptoms following VZV infection should raise the possibility of intracranial complications.
• They emphasize prompt recognition, investigation, and management.