THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S PROBLEMS AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.
[10.50 am, 05/02/2026] PPM 1: MRI videos of the patient 👇
[10.11 am, 06/02/2026] PPM 1: O3 model earlier shared here https://pubmed.ncbi.nlm.nih.gov/37335625/
begins in this patient with the lesions on her skin that are often thought to be due to a very common virus (organism but dimensions away from bacteria or any cell in our body in terms of size and structure) that all humans can relate to as the common pox and this patient too presented with just those common symptoms including fatigue that is a common accompaniment of all similar virals as shared in these hand written notes
She was on thyroxine 50 mcg and not 100
Handwritten notes
[10:13 am, 06/02/2026] PPM 1: Till 2/2/26 the diagnosis is chronic fatigue myalgia post viral
[10:14 am, 06/02/2026] PPM 1: 👆@PPM3 you may recall one of your patients of chronic fatigue fibromyalgia syn in this context
[10:16 am, 06/02/2026] PPM 3: Btw whosever handwriting this is, should get the best handwriting award in medicine!
[10:16 am, 06/02/2026] PPM 1: Same day at night events unfolded with a seizure activating various current standard of care testing treatment protocols with CSF, MRI etc and antivirals into the mix
[10:17 am, 06/02/2026] PPM 1: Hope s/he is in the group @PPM4?
[10:17 am, 06/02/2026] PPM 5: It's @PPM6's handwriting sir
[10.18 am, 06/02/2026] PPM 1: 👏
[10:20 am, 06/02/2026] PPM 4: Yes sir she is there
[10:23 am, 06/02/2026] PPM 1: MRI as linked here https://pajrcasereporter.blogspot.com/2026/02/35f-vzv-encephalitis-seizures-csvt.html?m=1
revealed a non visualization of transverse sinus bringing forth a diagnosis of cerebral venous sinus thrombosis
Please find the report attached here
[10:28 am, 06/02/2026] PaJR Health: Yes, there is a reported connection between varicella virus infection and the development of cerebral venous sinus thrombosis (CVST). Several case reports and reviews in the medical literature describe this association, both with primary varicella (chickenpox) and with reactivated varicella zoster virus (herpes zoster or shingles).
💡 *KEY INSIGHTS*
* Varicella zoster virus (VZV) infection, in both its primary form (chickenpox) and reactivated form (shingles), has been linked to cerebral venous sinus thrombosis [1, 2, 3, 4, 5, 6, 7, 8].
* The proposed mechanisms for this association include vasculopathy, direct endothelial damage by the virus, and acquired antibody-mediated hypercoagulable states, such as acquired protein S deficiency secondary to molecular mimicry [1, 4, 7, 8].
* Early diagnosis and prompt treatment are considered essential for managing this serious complication [3, 7].
*REFERENCES*
1. Chronic Headache and Cerebral Venous Sinus Thrombosis Due to Varicella Zoster Virus Infection: A Case Report and Review of the Literature - https://pubmed.ncbi.nlm.nih.gov/33727523/
2. Cerebral Venous Sinus Thrombosis: Its Association with Primary Varicella-Zoster Virus Infection - https://pubmed.ncbi.nlm.nih.gov/34979730/
3. Acute Cerebral Venous Sinus Thrombosis: A Rare Complication of Primary Varicella Zoster Virus Infection - https://pubmed.ncbi.nlm.nih.gov/33042243/
4. Cerebral Venous Thrombosis and Acute Pulmonary Embolism following Varicella Infection - https://pubmed.ncbi.nlm.nih.gov/31742195/
5. Cerebral Venous Sinus Thrombosis Following Varicella Infection: A Case Report - https://pubmed.ncbi.nlm.nih.gov/39469279/
6. Cerebral Venous Sinus Thrombosis Complicating Herpes Zoster Ophthalmicus Ophthalmoplegia - https://pubmed.ncbi.nlm.nih.gov/38646240/
7. Cerebral venous sinus thrombosis as a complication of primary varicella infection in a child, case report - https://pubmed.ncbi.nlm.nih.gov/35003724/
8. Cerebral venous sinus thrombosis: association with primary varicella zoster virus infection - https://pubmed.ncbi.nlm.nih.gov/22682971/
[10:31 am, 06/02/2026] PPM 7: https://pmc.ncbi.nlm.nih.gov/articles/PMC11706435/
[1:34 pm, 06/02/2026] PPM 8: https://share.google/aimode/gcTo0dzqxuTdVTP0b
[1:35 pm, 06/02/2026] PPM 8: AI Mode
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Yes, there is a reported connection between the varicella-zoster virus (VZV) and cerebral venous sinus thrombosis (CVST), though it is considered a very rare complication. While VZV is more commonly associated with arterial strokes, it has been linked to venous thrombosis during both primary infection (chickenpox) and reactivation (shingles).
Reported Mechanisms
Researchers have proposed several pathways for how VZV may trigger CVST:
Acquired Hypercoagulable State: The infection can lead to a transient deficiency in natural anticoagulants, specifically Protein S and Protein C.
Autoantibody Induction: In some cases, the virus induces the production of antiphospholipid antibodies or anti-protein S antibodies, a phenomenon sometimes called "varicella autoantibody syndrome".
Direct Endothelial Damage: The virus may directly infect and damage the vascular endothelium, promoting local clot formation.
VZV Vasculopathy: The virus can travel transaxonally to dural sinuses (which are innervated by the trigeminal nerve), leading to inflammatory vascular wall remodeling.
Clinical Presentation
Onset: Symptoms typically appear within 2 to 3 weeks after the onset of the characteristic VZV rash, though cases have been reported as early as 5–7 days post-rash.
Common Symptoms: Patients often present with severe headache (sometimes thunderclap), fever, seizures, or focal neurological deficits like hemiparesis.
Prognosis: While potentially life-threatening, most reported cases have shown favorable outcomes when treated promptly with a combination of intravenous acyclovir and anticoagulation (such as heparin or warfarin).
Are you inquiring about a specific case or looking for more detailed diagnostic criteria for VZV-associated vasculopathy?
This is for informational purposes only. For medical advice or diagnosis, consult a professional. AI responses may include mistakes. Learn more
Cerebral venous sinus thrombosis as a complication of primary varicella ...
ScienceDirect.com
Chronic Headache and Cerebral Venous Sinus Thrombosis Due to ...
American Journal of Case Reports
Cerebral Venous Sinus Thrombosis Secondary to Varicella Zoster Virus ...
Neurology® Journals
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AI Mode response is ready
[1:59 pm, 06/02/2026] PPM 2: @PPM1 Sir good to see that it is synthesizing a short thesis with clear in text citations and clickable links
[1:59 pm, 06/02/2026] PaJR Health: Thank you for your feedback! I'm glad to hear that the synthesis, in-text citations, and clickable links are helpful. I strive to provide clear and well-referenced information.
[12.13 pm, 06/02/2026] PPM 8: Yes, there is a documented, though rare, connection between primary varicella (chickenpox) infection and the development of cerebral venous sinus thrombosis (CVST). While it is a well-recognized neurological complication, it occurs in less than 1% of chickenpox cases.
Below is a summary of key case reports that established and confirm this association:
| **Case Report (Year)** | **Patient Age** | **Key Findings & Clinical Context** |
| :--- | :--- | :--- |
| **Siddiqi et al. (2012)** | Not specified | Reported two landmark cases. At the time, they noted there were "no published reports" of CVST with primary VZV infection, establishing this as a newly recognized association. |
| **Khan et al. (2019)** | 26-year-old male | Presented with **both CVST and acute pulmonary embolism** after chickenpox, highlighting the systemic, hypercoagulable state induced by the virus. |
| **Badour et al. (2021)** | 5-year-old female | Demonstrated that this complication also occurs in **children**. The patient had a hemorrhagic infarct but recovered completely with treatment. |
| **Dablouk et al. (2024)** | 38-year-old male | A recent adult case presenting with severe headache. Successfully treated with anticoagulants (warfarin for one year) with full symptom resolution. |
| **Palanisamy et al. (2025)** | 34-year-old male | Another recent adult case, discussing the **virus-induced hypercoagulable state** as the likely mechanism. |
### 🔬 How Varicella Virus May Lead to CVST
Researchers propose several interconnected mechanisms:
- **Hypercoagulable State**: VZV infection can trigger a systemic state that promotes clotting. Studies show patients have significantly increased levels of **fibrinogen and D-dimer**.
- **Acquired Protein S Deficiency**: The virus can induce the body to produce **autoantibodies against Protein S**, a natural anticoagulant protein. This deficiency is a key finding in many reported cases.
- **Direct Vessel Damage (Vasculopathy)**: The virus may directly infect and damage the endothelial cells lining blood vessels, activating the clotting cascade. This is part of a broader condition known as VZV vasculopathy.
### ⏱️ Clinical Presentation and Timeline
- **Typical Onset**: Neurological symptoms like **severe headache** (the most common symptom), vomiting, seizures, or focal weakness usually appear **1-3 weeks after the chickenpox rash begins**.
- **Diagnosis**: Requires **imaging confirmation** via CT Venogram (CTV) or MR Venogram (MRV).
- **Treatment & Prognosis**: Standard treatment involves **anticoagulation therapy** (e.g., heparin, followed by warfarin or DOACs) and often **intravenous antiviral drugs** (e.g., acyclovir). With prompt diagnosis and treatment, the prognosis is generally good, and many patients achieve full recovery.
### 💎 Key Takeaway
Cerebral venous sinus thrombosis is a **rare but serious complication** of primary varicella infection, documented in both children and adults. The link is believed to be a virus-induced hypercoagulable state, often involving acquired Protein S deficiency. A high index of suspicion is needed in patients with a recent chickenpox rash who develop a severe, persistent headache or other neurological symptoms.
I hope this detailed review of the evidence is helpful for your understanding. If you are interested in the specific diagnostic criteria or the differences in management between pediatric and adult cases, I can provide further information.
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