High resolution vessel wall MRI and vasculopathy related to herpes zoster ophthalmicus

Varicella zoster virus is a common viral infection with over 50% of patients over the age of 80 years infected with the virus. Following reactivation, some patients succumb to complications of VZV reactivation with neurologic and optic pathway pathology such as VZV vasculopathy resulting in transient ischemic attacks, strokes, aneurysms, as well as optic neuritis. We show that high resolution vessel wall magnetic resonance imaging can aid in the diagnosis of this condition with circumferential wall thickening and enhancement of the infected vessels. Prompt diagnosis is critical as this is a treatable condition that could result in substantial morbidity or mortality if not recognized early.