May 12, 2015; 84 (19) Article
Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis
Don Gilden, Teresa White, Nelly Khmeleva, Anna Heintzman, Alexander Choe, Philip J. Boyer, Charles Grose, John E. Carpenter, April Rempel, Nathan Bos, Balasubramaniyam Kandasamy, Kelly Lear-Kaul, Dawn B. Holmes, Jeffrey L. Bennett, Randall J. Cohrs, Ravi Mahalingam, Naresh Mandava, Charles G. Eberhart, Brian Bockelman, Robert J. Poppiti, Madhura A. Tamhankar, Franz Fogt, Malena Amato, Edward Wood, Vikram Durairaj, Steve Rasmussen, Vigdis Petursdottir, Lea Pollak, Sonia Mendlovic, Denis Chatelain, Kathy Keyvani, Wolfgang Brueck, Maria A. Nagel
First published February 18, 2015, DOI: https://doi.org/10.1212/WNL.0000000000001409
Don Gilden
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Teresa White
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Nelly Khmeleva
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Anna Heintzman
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Alexander Choe
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Philip J. Boyer
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Charles Grose
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
John E. Carpenter
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
April Rempel
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Nathan Bos
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Balasubramaniyam Kandasamy
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Kelly Lear-Kaul
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Dawn B. Holmes
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Jeffrey L. Bennett
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Randall J. Cohrs
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Ravi Mahalingam
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Naresh Mandava
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Charles G. Eberhart
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Brian Bockelman
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Robert J. Poppiti
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Madhura A. Tamhankar
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Franz Fogt
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Malena Amato
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Edward Wood
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Vikram Durairaj
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Steve Rasmussen
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Vigdis Petursdottir
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Lea Pollak
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Sonia Mendlovic
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Denis Chatelain
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Kathy Keyvani
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Wolfgang Brueck
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Maria A. Nagel
From the Departments of Neurology (D.G., T.W., N.K., A.H., A.C., A.R., N.B., J.L.B., R.J.C., R.M., M.A.N.), Microbiology (D.G., R.J.C.), Pathology (P.J.B., B.K.), and Ophthalmology (J.L.B., N.M.), University of Colorado School of Medicine, Aurora; Children's Hospital (C.G., J.E.C.), University of Iowa, Iowa City; Arapahoe County Coroner's Office (K.L.-K.), Aurora, CO; Denver Office of the Medical Examiner (D.B.H.), Denver, CO; Department of Pathology (C.G.E.), Johns Hopkins University School of Medicine, Baltimore, MD; A.M. Rywlin Department of Pathology (B.B., R.J.P.), Mount Sinai Medical Center, Miami Beach, FL; Florida International University (B.B., R.J.P.), Miami Beach; Scheie Eye Institute (M.A.T.) and Department of Pathology and Laboratory Medicine (F.F.), University of Pennsylvania, Philadelphia; Texas Oculoplastic Consultants (M.A., E.W., V.D.), Austin; University of Texas, Southwestern – Austin Transitional Year Program (E.W.), Austin; Departments of Pathology and Laboratory Medicine, Ophthalmology, and Visual Sciences (S.R.), University of British Columbia, Vancouver, Canada; Landspitali University Hospital (V.P.), Reykjavik, Iceland; Department of Neurology (L.P.) and Pathological Institute (S.M.), Assaf Harofeh Medical Center, Zerifin, University of Tel Aviv, Israel; Department of Pathology (D.C.), Centre Hospitalier Universitaire du Nord and RECIP, Amiens, France; Institute of Neuropathology (K.K.), University of Duisburg-Essen, Germany; and Department of Neuropathology (W.B.), University Medical Center Gottingen, Germany.
Prevalence and distribution of VZV in temporal arteries of patients with giant cell arteritis
Don Gilden, Teresa White, Nelly Khmeleva, Anna Heintzman, Alexander Choe, Philip J. Boyer, Charles Grose, John E. Carpenter, April Rempel, Nathan Bos, Balasubramaniyam Kandasamy, Kelly Lear-Kaul, Dawn B. Holmes, Jeffrey L. Bennett, Randall J. Cohrs, Ravi Mahalingam, Naresh Mandava, Charles G. Eberhart, Brian Bockelman, Robert J. Poppiti, Madhura A. Tamhankar, Franz Fogt, Malena Amato, Edward Wood, Vikram Durairaj, Steve Rasmussen, Vigdis Petursdottir, Lea Pollak, Sonia Mendlovic, Denis Chatelain, Kathy Keyvani, Wolfgang Brueck, Maria A. Nagel
Neurology May 2015, 84 (19) 1948-1955; DOI: 10.1212/WNL.0000000000001409
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Abstract
Objective: Varicella-zoster virus (VZV) infection may trigger the inflammatory cascade that characterizes giant cell arteritis (GCA).
Methods: Formalin-fixed, paraffin-embedded GCA-positive temporal artery (TA) biopsies (50 sections/TA) including adjacent skeletal muscle and normal TAs obtained postmortem from subjects >50 years of age were examined by immunohistochemistry for presence and distribution of VZV antigen and by ultrastructural examination for virions. Adjacent regions were examined by hematoxylin & eosin staining. VZV antigen–positive slides were analyzed by PCR for VZV DNA.
Results: VZV antigen was found in 61/82 (74%) GCA-positive TAs compared with 1/13 (8%) normal TAs (p < 0.0001, relative risk 9.67, 95% confidence interval 1.46, 63.69). Most GCA-positive TAs contained viral antigen in skip areas. VZV antigen was present mostly in adventitia, followed by media and intima. VZV antigen was found in 12/32 (38%) skeletal muscles adjacent to VZV antigen–positive TAs. Despite formalin fixation, VZV DNA was detected in 18/45 (40%) GCA-positive VZV antigen–positive TAs, in 6/10 (60%) VZV antigen–positive skeletal muscles, and in one VZV antigen–positive normal TA. Varicella-zoster virions were found in a GCA-positive TA. In sections adjacent to those containing VZV, GCA pathology was seen in 89% of GCA-positive TAs but in none of 18 adjacent sections from normal TAs.
Conclusions: Most GCA-positive TAs contained VZV in skip areas that correlated with adjacent GCA pathology, supporting the hypothesis that VZV triggers GCA immunopathology. Antiviral treatment may confer additional benefit to patients with GCA treated with corticosteroids, although the optimal antiviral regimen remains to be determined.
GLOSSARY
- CI=
- confidence interval;
- FFPE=
- formalin-fixed, paraffin-embedded;
- GAPdH=
- glyceraldehyde-3-phosphate-dehydrogenase;
- GCA=
- giant cell arteritis;
- gE=
- glycoprotein E;
- HSV=
- herpes simplex virus;
- SEM=
- scanning electron microscopy;
- TA=
- temporal artery;
- TEM=
- transmission electron microscopy;
- VZV=
- varicella-zoster virus
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1918
Supplemental data at Neurology.org
- Received December 31, 2014.
- Accepted in final form January 27, 2015.
- © 2015 American Academy of Neurology
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Letters: Rapid online correspondence
- Author Response to Dr. Lavi
- Don Gilden, University of Colorado School of MedicineDon.Gilden@ucdenver.edu
- Maria Nagel, Teresa White, Auorora, CO; Charles Grose, Iowa City
Submitted August 10, 2015 - Is temporal arteritis due to VZV infection?
- Ehud Lavi, Professor and Chief of Neuropathology, Weill Cornell Medical Collegeehl2005@med.cornell.edu
Submitted August 05, 2015 - Basal cerebral artery involvement in Giant cell arteritis - A Varicella-zoster virus vasculopathy?
- Suresh K Chhetri, Neurologist, Royal Preston Hospitalchhetri@doctors.org.uk
Submitted May 26, 2015
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