This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
To the Editor:
Nagel and colleagues1 are to be congratulated on their collaborative review characterizing varicella zoster virus (VZV) vasculopathy in a series of 30 patients. However, they may have overstated their estimate of the sensitivity of virologic testing, particularly that for anti-VZV IgG antibody in the CSF, which was 93.3%.
The case definition they used for VZV vasculopathy was based on the presence in CSF of VZV DNA by PCR or anti-VZV IgG antibody, or both. Because there was no independent gold standard, such as biopsy evidence of virus or inflammation in brain vessels, against which their presumptive diagnosis was being compared, the calculation of sensitivity of these CSF findings may be interpreted as the result of circular reasoning and should be treated with caution.
It would be impossible to know whether some of their diagnoses represented false positives. It is plausible that some cases represented patients in whom intrathecal anti-VZV antibody synthesis occurred secondary to recent zoster, but in whom stroke or vasculopathy had an alternative cause, including atherosclerosis, dissection, or other etiology. Both stroke and zoster are common enough that …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Costs and Utilization of New-to-Market Neurologic Medications
Dr. Robert J. Fox and Dr. Mandy Leonard