Analysis of clinical characteristics of central nervous system varicella-zoster virus infection: A Single-Center Cases Series Study

Abstract

Backgroud: To retrospectively analyze the clinical characteristics, laboratory examination, electroencephalogram, imaging findings, treatment and prognosis of central nervous system varicella-zoster virus (VZV) infection confirmed by metagenomic next-generation sequencing (mNGS), and to improve the early recognition of the disease. Methods: Patients with VZVencephalitis/meningitis or spinal meningitis diagnosed by mNGS of cerebrospinal fluid (CSF) in the Department of Neurology of the Second Hospital of Hebei Medical University from July 2018 to June 2021 were enrolled. The clinical characteristics, laboratory examination, electroencephalogram, imaging examination, diagnosis, treatment and prognosis were collected and analyzed. Results: All the 29 patients had acute onset, and the main clinical manifestations were headache, fever, cranial nerve damage, disturbance of consciousness, limb numbness and weakness, convulsion, etc. There were 8 cases of meningitis, 18 cases of meningoencephalitis, 2 cases of cerebrospinal meningitis and 1 case of myelomeningitis. The pressure of lumbar puncture was normal in most cases. The white blood cell count and protein content in CSF were increased remarkable. The abnormal rate of electroencephalogram (EEG) was low, and abnormal imaging could be found in severe cases. Most of the patients can obtain a good prognosis, but those with cranial nerve involvement, vasculitis or spinal cord injury often have poor prognosis. Conclusions: The clinical manifestations of VZV infection in central nervous system are nonspecific, and cranial nerves are prone to be involved. CSF parameters are diverse, which is easy to be misdiagnosed. CSF cytology can provide valuable clue for clinical diagnosis.