Thane docs save life of man after solving six-month-long stroke mystery 

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A 42-year-old man had been suffering from recurrent strokes, seizures and progressive neurological symptoms for nearly six months. After multiple evaluations failed to identify the underlying cause, advanced diagnostic testing revealed a rare complication of chickenpox virus reactivation that causes inflammation and narrowing of blood vessels in the brain.

The man’s symptoms began nine months back with persistent headaches that initially responded to medication but gradually worsened. An MRI performed a few weeks later revealed small areas of stroke, and despite treatment with blood-thinning medication, he developed recurrent neurological symptoms, including speech difficulties. Over the following weeks, repeated brain imaging showed multiple areas of new small strokes without any obvious blockage in the major blood vessels of brain, making it difficult to identify the underlying cause.

An extensive diagnostic evaluation was carried out, including cardiac assessment, clotting disorder screening, autoimmune investigations, and spinal fluid analysis. While several possible causes, including infection and inflammation, were considered and treated, the patient experienced only temporary improvement. Over the next few months, he continued to suffer recurrent episodes of headaches, confusion, memory impairment, drowsiness, and repeated strokes, with the exact diagnosis remaining elusive.

By the time he was admitted to Jupiter Hospital in Thane, his condition had deteriorated significantly. He presented with severe headaches, recurrent seizures, disorientation and reduced consciousness requiring ventilator support. Brain imaging revealed fresh strokes, prompting the neurology team, led by Dr. Aniruddha More, Consultant, Neurologist, Jupiter Hospital, Thane to undertake a detailed reassessment to identify the underlying cause and initiate the appropriate treatment.

The team reassessed the case and considered multiple possibilities, including primary CNS vasculitis, antibody-negative autoimmune brain inflammation and rare blood cancers affecting blood vessels.

A specialised angiogram, known as digital subtraction angiography (DSA), revealed blood clots in major draining veins of the brain — the straight sinus and vein of Galen — along with partial clotting in smaller cortical veins. The patient was started on blood thinners (anticoagulants) and high-dose steroids, leading to significant improvement within few days. He regained full alertness and was taken off ventilator support within three days.

Despite this recovery, the underlying cause remained unclear. Further evaluation for lymphoma, autoimmune disorders, demyelinating diseases and rare antibody markers for immunological disorders returned negative results. As cyclophosphamide, a powerful immune-suppressing chemotherapy medication, was being considered, the team decided to conduct one final spinal fluid and blood evaluation to conclusively rule out any infections in the body and brain. 

The final test revealed a crucial finding — the patient’s spinal fluid tested positive for antibodies against the v aricella-zoster virus (VZV), a virus known to cause chicken pox and Herpes Zoster/shingles. This confirmed the diagnosis of VZV vasculopathy, where reactivation of the dormant chickenpox virus causes inflammation of brain blood vessels, leading to recurrent strokes.

The diagnosis changed the treatment approach. Instead of proceeding with immune-suppressing chemotherapy, the patient was started on intravenous acyclovir, an antiviral medication, along with continued anti-clotting therapy. He responded well, with no further strokes or relapses of clinical symptoms. Follow-up imaging over the next two months showed progressive healing, and by July 2026 — nine months after symptom onset — scans demonstrated near-complete resolution of inflammation, no new strokes and complete neurological recovery.

Dr Aniruddha More said, “This was a difficult case because the patient’s condition evolved over time, making it challenging to identify the exact cause. The patient was close to receiving chemotherapy-level immunosuppression for a condition that actually required antiviral treatment. Identifying VZV vasculopathy at the right time helped us provide the correct therapy and prevent further neurological damage.”

He added, “VZV vasculopathy remains under-recognised because nearly one-third of patients may not develop the typical shingles rash. Routine infection tests can also miss the diagnosis unless specific testing for VZV antibodies in spinal fluid is performed.”

“In younger patients presenting with recurrent unexplained strokes, clinicians must consider treatable causes before initiating aggressive immunosuppressive therapies. In this case, one additional investigation at a critical stage changed the treatment pathway and the patient’s outcome,” Dr More further explained

The case highlights how persistence in diagnosis can be just as important as treatment itself. In patients with recurrent unexplained strokes, especially younger adults without clear risk factors, considering rare but reversible conditions such as VZV vasculopathy can be lifesaving. Timely diagnosis not only prevents irreversible neurological damage but also ensures patients receive the right treatment instead of unnecessary aggressive therapies.