Herpes Zoster Associated Encephalitis: Clinical Findings and Acyclovir Treatment

Abstract

The clinical course of herpes zoster associated encephalitis (HZAE) with special emphasis on the treatment with acyclovir is described from the experience in 14 own patients and 47 review cases. Immunosuppression and dissemination involved increased risk of HZAE, whereas cranial zoster implied no or only a slightly increased risk. The symptoms were mainly disturbances of mental function and ataxia. Nuchal rigidity was noted in approximately one third of cases. The median duration from dermatomal lesion to HZAE was 15 days in immunosuppressed patients versus 5 days in non-immunosuppressed patients. Abnormal spinal fluid findings included mononuclear pleocytosis, occasionally with low glucose concentration. Protein was elevated in half of the patients. Serum sodium levels were often low. Brain CAT scans were generally normal and EEGs always abnormal. Recurrence of HZAE was noted in 2 patients. Treatment with acyclovir seemed to have a beneficial effect. The results, however, need cautious interpretation due to the heterogenous patient material. Two patients developed signs of HZAE while on treatment with desciclovir but recovered during ongoing therapy.

Subcortical type cognitive impairment in herpes zoster encephalitis

“…In VZV similar localization has not been observed. As in HSV encephalitis, acyclovir is used in the treatment of VZV infections [41 ].…”

Infections of the Nervous System Caused by Varicella-Zoster Virus: A Review

“…In some patients, encepha litis is combined with psychosis and cranial or extracran ial nerve palsies [38], The average duration of the disease is 16 days, although some symptoms and signs may persist for months. Recurrence has also been reported [18,39,40] , The mortality rate attributed directly to encephalitis ranges from 4% to more than 25% [18,38,40], Residual morbidity, such as motor weakness and cranial nerve pal sies. is present in about 30% of survivors.…”

“…CSF and EEG are frequently abnormal, similar to those of the varicella encephalitis. CT of the brain is usually normal, however [13,40], CSF abnormalities such as lymphocytic pleocytosis and elevated protein content may be observed in up to 40% patients with uncomplicated HZ, probably as a con sequence of ganglionitis. Clinical meningitis associated with HZ has been considered to be extremely rare [13,41] .…”

“…In cases of encephalitis associated with zoster, the brain involvement tends to be diffuse and patients show normal images in CT studies [40], This lack of focality has limited the use of the brain biopsy for diag nosis. Although detection of viral particles in CSF by con ventional electron microscopy (EM) has been reported at least in 1 case of VZV meningoencephalitis [94], the con centration of full particles is likely to be too low to make EM practical in diagnosis.…”

“…Narcotics (e.g., oxycodone) may be effective but there is a risk of sedation and dependence. The patient must be referred to a pain clinic if the pain is severe and resistant [125,126], Therapy with acyclovir is recommended in the NC that are serious and supposedly caused by a direct effect of virus, such as HZE [40,127]. myelitis [59,60] and granulomatous angiitis [14,128], Other antiviral drugs with therapeutic potential in VZV infections arc valacyclovir, famciclovir, ganciclovir, and sorivudine [15,[129][130][131],…”